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General NPI Number Information
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NPI Number | 1114003779
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Entity Type | Organization
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Legal Business Name | VALDOSTA FAMILY MEDICINE ASSOCIATES, P.C.
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 12/28/2021
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Provider Practice Location Address
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Address Line | 2412 N OAK ST
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City | VALDOSTA
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State | GA
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Zip | 31602-2567
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Country | US
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Telephone | 229-244-1400
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Fax | 229-244-5512
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Provider Business Mailing Address
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Address Line | 2412 N OAK ST
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City | VALDOSTA
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State | GA
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Zip | 31602-2567
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Country | US
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Telephone | 229-244-1400
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Fax | 229-244-5512
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | CRAIG E BISHOP
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Credential | D.O.
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Telephone | 229-244-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIRO02539
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 029930
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 029951
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 030242
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 044001
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License Number State | GA
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Taxonomy #6
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 041290
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License Number State | GA
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Taxonomy #7
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 041978
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License Number State | GA
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Taxonomy #8
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 008563
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License Number State | GA
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Taxonomy #9
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 003072
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License Number State | GA
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Taxonomy #10
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 004849
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License Number State | GA
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Taxonomy #11
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 004094
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License Number State | GA
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Taxonomy #12
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN154901
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License Number State | GA
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Taxonomy #13
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 045725
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License Number State | GA
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