Organization
AIRPORT CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE GRAHAM (PRESIDENT)
(229) 242-9003
Entity
Organization
Contact information
Practice address
704 GIL HARBIN INDUSTRIAL BLVD, VALDOSTA, GA 31601-6513
(229) 242-9003
Mailing address
704 GIL HARBIN INDUSTRIAL BLVD, VALDOSTA, GA 31601-6513
(229) 242-9003
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
227527287B
—
GA
Enumeration date
04/30/2008
Last updated
11/21/2013
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