Organization
VALDOSTA FOOT & ANKLE SURGERY CENTER, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGIE TYSON (OFFICE MANAGER)
(229) 244-1211
Entity
Organization
Contact information
Practice address
2800 N OAK ST, VALDOSTA, GA 31602-1716
(229) 244-1211
(229) 244-2721
Mailing address
2800 N OAK ST, VALDOSTA, GA 31602-1716
(229) 244-1211
(229) 244-2721
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
092-193
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202G494969
MEDICARE PTAN
GA
Enumeration date
10/19/2007
Last updated
09/04/2014
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