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General NPI Number Information
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NPI Number | 1215574926
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Entity Type | Organization
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Legal Business Name | SOUTHWELL AMBULATORY INC
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Dates
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Enumeration Date | 12/02/2019
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 3790 OLD US 41 N STE C
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City | VALDOSTA
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State | GA
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Zip | 31602-6867
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Country | US
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Telephone | 229-262-6800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2650
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City | TIFTON
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State | GA
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Zip | 31793-2650
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Country | US
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Telephone | 229-353-3422
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Fax | 229-391-4059
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Authorized Official
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Title or Position | SVP/CFO
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Name | TROY BROOKS
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Credential |
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Telephone | 292-353-3397
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number |
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License Number State |
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