Healthcare Provider Details

I. General information

NPI: 1477487486
Provider Name (Legal Business Name): VIDALIA HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

368 S MAIN ST
BAXLEY GA
31513-0104
US

IV. Provider business mailing address

368 S MAIN ST
BAXLEY GA
31513-0104
US

V. Phone/Fax

Practice location:
  • Phone: 912-366-1981
  • Fax:
Mailing address:
  • Phone: 912-366-1981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JARED KIRBY
Title or Position: CFO
Credential:
Phone: 912-535-8691