Individual
DR. JOSE MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3334 GREYSTONE WAY, VALDOSTA, GA 31605
(229) 247-1667
(229) 245-7661
Mailing address
PO BOX 3550, VALDOSTA, GA 31604-3550
(229) 247-1667
(229) 245-7661
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
041166
GA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
041166
GA
207RP1001X
Pulmonary Disease Physician
Primary
041166
GA
207RS0012X
Sleep Medicine (Internal Medicine) Physician
041166
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000686507C
—
GA
Enumeration date
10/04/2005
Last updated
04/19/2012
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