Healthcare Provider Details

I. General information

NPI: 1134148208
Provider Name (Legal Business Name): VALDOSTA ANESTHESIA ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N PATTERSON ST
VALDOSTA GA
31602-1735
US

IV. Provider business mailing address

PO BOX 3670
VALDOSTA GA
31604-3670
US

V. Phone/Fax

Practice location:
  • Phone: 229-996-5665
  • Fax: 229-242-2385
Mailing address:
  • Phone: 229-996-5665
  • Fax: 229-242-2385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: EMMETT W BOWERS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 229-996-5665