Healthcare Provider Details

I. General information

NPI: 1649462466
Provider Name (Legal Business Name): BETH A VOLINGAVAGE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15196 US HIGHWAY 19 S
THOMASVILLE GA
31757-4820
US

IV. Provider business mailing address

8614 WESTWOOD CENTER DR FL 9
VIENNA VA
22182-2442
US

V. Phone/Fax

Practice location:
  • Phone: 229-228-4770
  • Fax: 229-225-9060
Mailing address:
  • Phone: 703-847-8899
  • Fax: 571-223-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT 002266
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: