Organization
SOUTHWELL AMBULATORY INC
Active
Other names
Southwell Primary Care
Organization subpart
No
Provider details
NPI number
Authorized official
TROY BROOKS (SVP/CFO)
(229) 353-3397
Entity
Organization
Contact information
Practice address
2922 N OAK ST STE C, VALDOSTA, GA 31602-1885
(229) 262-6819
Mailing address
410 CONNELL RD, VALDOSTA, GA 31602-1898
(229) 353-6889
(229) 219-1631
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
03/09/2021
Last updated
10/18/2022
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