=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538039292
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALDOSTA ADVANCED HEALING INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2025
-----------------------------------------------------
Last Update Date | 12/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 BAYTREE RD STE D
-----------------------------------------------------
City | VALDOSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31602-2881
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-381-6736
-----------------------------------------------------
Fax | 833-381-6628
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8801 BALLENTINE ST STE 400
-----------------------------------------------------
City | OVERLAND PARK
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66214-2082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-381-6736
-----------------------------------------------------
Fax | 833-381-6628
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | AMY A CHAVEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 833-381-6736
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------