Healthcare Provider Details

I. General information

NPI: 1437290855
Provider Name (Legal Business Name): LOWNDES ADVOCACY RESOURCE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1646 E PARK AVE
VALDOSTA GA
31602-3413
US

IV. Provider business mailing address

1646 E PARK AVE
VALDOSTA GA
31602-3413
US

V. Phone/Fax

Practice location:
  • Phone: 229-244-8290
  • Fax: 229-244-3458
Mailing address:
  • Phone: 229-244-8290
  • Fax: 229-244-3458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. HARRY A HAMM
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 229-244-8290