Provider Demographics
NPI:1053457457
Name:VALDOSTA ORTHOPEDIC ASSOCIATES PC
Entity Type:Organization
Organization Name:VALDOSTA ORTHOPEDIC ASSOCIATES PC
Other - Org Name:VALDOSTA ORTHOPEDIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:E
Authorized Official - Last Name:AGUERO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:229-247-2290
Mailing Address - Street 1:3527 N VALDOSTA ROAD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1068
Mailing Address - Country:US
Mailing Address - Phone:229-247-2290
Mailing Address - Fax:229-244-2626
Practice Address - Street 1:3527 N VALDOSTA ROAD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1068
Practice Address - Country:US
Practice Address - Phone:229-247-2290
Practice Address - Fax:229-244-2626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000304554DMedicaid
GA000544662AMedicaid
GA000954445AMedicaid
GA000327973BMedicaid
GA000653353AMedicaid
GAGRP1215OtherMEDICARE PTAN
0367170001Medicare NSC