Individual
JOSEPH DANIEL SOUDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3301 N OAK STREET EXT, VALDOSTA, GA 31605-1014
(229) 242-6061
(229) 242-6151
Mailing address
3301 N OAK STREET EXT, VALDOSTA, GA 31605
(229) 242-6061
(229) 242-6151
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8415
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003193212A
—
GA
Enumeration date
07/18/2017
Last updated
12/06/2018
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