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General NPI Number Information
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NPI Number | 1831134121
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Entity Type | Organization
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Legal Business Name | VALDOSTA ENDOSCOPY CENTER, LLC
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 06/08/2012
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Provider Practice Location Address
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Address Line | 410 CONNELL RD
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City | VALDOSTA
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State | GA
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Zip | 31602-1407
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Country | US
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Telephone | 229-244-1570
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Fax | 229-247-1084
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Provider Business Mailing Address
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Address Line | 410 CONNELL RD
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City | VALDOSTA
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State | GA
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Zip | 31602-1407
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Country | US
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Telephone | 229-244-1570
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Fax | 229-247-1084
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ERIC M WARD
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Credential | MD
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Telephone | 229-244-1570
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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 | 092-243
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License Number State | GA
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