Provider Demographics
NPI:1073556338
Name:VALDOSTA PODIATRY ASSOCIATES, PC
Entity Type:Organization
Organization Name:VALDOSTA PODIATRY ASSOCIATES, PC
Other - Org Name:NORTH OAK AMBULATORY SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:E
Authorized Official - Last Name:PITTS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:229-242-3668
Mailing Address - Street 1:2718 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1781
Mailing Address - Country:US
Mailing Address - Phone:229-242-3668
Mailing Address - Fax:229-253-8666
Practice Address - Street 1:2718 N OAK ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1781
Practice Address - Country:US
Practice Address - Phone:229-242-3668
Practice Address - Fax:229-253-8666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA092-146261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000489673AMedicaid
GA111035ASCAMedicare ID - Type Unspecified