Provider Demographics
NPI:1144404484
Name:VALDOSTA UROLOGICAL ASSOCIATES
Entity Type:Organization
Organization Name:VALDOSTA UROLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SULE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-244-1736
Mailing Address - Street 1:3543 NORTH CROSSING CIRCLE
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602
Mailing Address - Country:US
Mailing Address - Phone:229-244-1736
Mailing Address - Fax:229-242-5666
Practice Address - Street 1:3543 NORTH CROSSING CIRCLE
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602
Practice Address - Country:US
Practice Address - Phone:229-244-1736
Practice Address - Fax:229-242-5666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042458174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00718891AMedicaid
GAF84951Medicare UPIN