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General NPI Number Information
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NPI Number | 1982085197
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Entity Type | Organization
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Legal Business Name | AZALEA NEURO AND SPINE CLINIC PC
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Dates
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Enumeration Date | 06/12/2015
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Last Update Date | 11/02/2015
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Provider Practice Location Address
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Address Line | 2109 N PATTERSON ST
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City | VALDOSTA
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State | GA
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Zip | 31602-2990
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Country | US
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Telephone | 229-469-7271
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Fax | 844-662-3122
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Provider Business Mailing Address
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Address Line | 2109 N PATTERSON ST
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City | VALDOSTA
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State | GA
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Zip | 31602-2990
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Country | US
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Telephone | 229-469-7271
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Fax | 844-662-3122
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Authorized Official
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Title or Position | OWNER
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Name | DR. HITHAM KHALIL
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Credential | MD
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Telephone | 229-469-7271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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