Provider Demographics
NPI:1780228320
Name:VALDOSTA ADDICTION ASSOCIATES, INC
Entity Type:Organization
Organization Name:VALDOSTA ADDICTION ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:COOPER
Authorized Official - Last Name:FOLSOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-242-0953
Mailing Address - Street 1:2935 N ASHLEY ST STE 114
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1788
Mailing Address - Country:US
Mailing Address - Phone:229-242-0953
Mailing Address - Fax:
Practice Address - Street 1:2301 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2647
Practice Address - Country:US
Practice Address - Phone:229-242-0953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone