Organization
SOUTHERN OB GYN ASSOCIATES P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY J JOHNSON (ADMINISTRATOR)
(229) 241-2800
Entity
Organization
Contact information
Practice address
220 NORTHSIDE DR, VALDOSTA, GA 31602-1858
(229) 241-2800
(229) 241-0454
Mailing address
220 NORTHSIDE DR, VALDOSTA, GA 31602-1858
(229) 241-2800
(229) 241-0454
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300020233A
—
GA
05
—
300020233B
—
GA
Enumeration date
12/26/2006
Last updated
06/18/2010
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