Organization
SOUTH GEORGIA CSB
Active
Other names
Lowndes DD Services
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUE GUPTON (CHIEF EXECUTIVE OFFICER)
(229) 671-6101
Entity
Organization
Contact information
Practice address
1644 E PARK AVE, VALDOSTA, GA 31602-3413
(229) 249-4900
(229) 249-4910
Mailing address
1644 E PARK AVE, VALDOSTA, GA 31602-3413
(229) 249-4900
(229) 249-4910
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000607032V
—
GA
05
—
000607032X
—
GA
Enumeration date
11/20/2006
Last updated
12/15/2008
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