Organization
SOUTHERN OB GYN AMBULATORY SURGERY CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PAM HALL R.N. (SURGICAL DIRECTOR)
(229) 241-2800
Entity
Organization
Contact information
Practice address
341 CONNELL RD, VALDOSTA, GA 31602-1471
(229) 241-2800
(229) 242-2402
Mailing address
341 CONNELL RD, VALDOSTA, GA 31602-1471
(229) 241-2800
(229) 242-2402
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
092-272
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
463124632A
—
GA
Enumeration date
06/30/2005
Last updated
08/22/2020
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