Healthcare Provider Details

I. General information

NPI: 1336152230
Provider Name (Legal Business Name): BRIAN S CHADWICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 PINECLIFF DR
VALDOSTA GA
31602-2239
US

IV. Provider business mailing address

2125 PINECLIFF DR
VALDOSTA GA
31602-2239
US

V. Phone/Fax

Practice location:
  • Phone: 706-812-2229
  • Fax: 706-882-6455
Mailing address:
  • Phone: 64-025-5097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number43575
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number043575
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number043575
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number43575
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number43575
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: