NPIMap

Organization Active NPI

Southwell Ambulatory Inc

  • Gastroenterology Physician
  • Valdosta, GA
National Provider Identifier
1164069472
Registry record updated Oct 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
SOUTHWELL AMBULATORY INC
Practice address
2922 N Oak St Ste C
Valdosta, GA 31602-1885
Phone
(229) 244-1570
Fax
(229) 299-4291
NPI assigned
Dec 5, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Troy Brooks
Title
SVP/Cfo
Phone
(229) 353-3397

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

2922 N Oak St Ste C
Valdosta, GA 31602-1885

Mailing address

PO Box 2650
Tifton, GA 31793-2650
Phone (229) 353-3422

Other practice location 1

3790 Old US 41 N Ste B
Valdosta, GA 31602-6866
Phone (229) 262-6800

Other names 1

  • Southwell Gastroenterology Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200224001260 GA Part B Supplier - Clinic/Group Practice 9234566779 Receives reassigned benefits from 16 practitioners
6 other NPIs on this enrollment
Practice locations: Adel, GA; Valdosta, GA; Tifton, GA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2312907Southwell Gastroenterology2922 N Oak Street, Suite C, Valdosta, GA 31602Certificate of waiverOct 21, 2026

National Provider Directory

National Provider Directory
Tax ID family
Southwell Lowndes Endoscopy7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3790 Old US Highway 41 N
Ste B
Valdosta, GA 31602
Phone (229) 241-8811

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/20731/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1575504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761523200000",
    "number": "1164069472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2650",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317932650",
            "telephone_number": "229-353-3422",
            "fax_number": "229-353-6060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2922 N OAK ST STE C",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021885",
            "telephone_number": "229-244-1570",
            "fax_number": "229-299-4291"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3790 Old US 41 N Ste B",
            "address_purpose": "LOCATION",
            "city": "Valdosta",
            "state": "GA",
            "postal_code": "316026866",
            "country_code": "US",
            "telephone_number": "229-262-6800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHWELL AMBULATORY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-05",
        "last_updated": "2025-10-27",
        "certification_date": "2025-10-27",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "TROY",
        "authorized_official_title_or_position": "SVP/CFO",
        "authorized_official_telephone_number": "229-353-3397"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southwell Gastroenterology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southwell Gastroenterology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Valdosta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.