Organization
JOSE MEDINA MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSE MEDINA MD (OWNER)
(229) 247-1667
Entity
Organization
Contact information
Practice address
3334 GREYSTONE WAY, VALDOSTA, GA 31605-1096
(229) 247-1667
(229) 247-3456
Mailing address
PO BOX 3550, VALDOSTA, GA 31604-3550
(229) 247-1667
(229) 247-3456
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
041166
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00686507C
—
GA
Enumeration date
08/07/2007
Last updated
06/15/2010
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