Organization
AZALEA SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIDGETT MOORE MD (MEDICAL DIRECTOR)
(229) 259-0019
Entity
Organization
Contact information
Practice address
2810 NORTH OAK STREET, VALDSOTA, GA 31602
(229) 259-0019
(229) 259-0209
Mailing address
2810 N OAK ST, VALDOSTA, GA 31602-1716
(229) 259-0019
(229) 259-0209
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
092266
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
598880
BCBS GA PROVIDER #
GA
Enumeration date
05/04/2007
Last updated
04/16/2008
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