Valdosta Health & Wellness Clinic Inc

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

Legal business name

VALDOSTA HEALTH & WELLNESS CLINIC INC

Practice address

3328 Bemiss Rd
Valdosta, GA 31605-7014

Phone

(229) 469-6137

Fax

(229) 469-6139

NPI assigned

Dec 9, 2014

Organization subpart

No

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

Authorized official

Name

Tracey Q LivingstonNPI 1578869830

Title

Owner

Phone

(229) 469-6137

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

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

CLIA laboratory certificates

Practitioners 9

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

• Tracey Q Livingston, ANP-BC

  • Adult Health Nurse Practitioner
  • Valdasta, GA
  • NPI 1578869830

  Adult Health, GA

  Medicare reassignment NPD Authorized official
• Rita Drake Cook, APRN

  • Women's Health Nurse Practitioner
  • Valdosta, GA
  • NPI 1346679537
  NPD
• Amanda Martin Moore, D.P.T., OT

  • Physical Therapist
  • Valdosta, GA
  • NPI 1982924635
  NPD
• Alden M Bass, PT, DPT

  • Orthopedic Physical Therapist
  • Valdosta, GA
  • NPI 1558078923
  NPD (past)
• Cathy J. Durland, PT

  • Physical Therapist
  • Albany, GA
  • NPI 1093808487
  NPD (past)
• Halleigh Lane Lovein, NP

  • Family Nurse Practitioner
  • Valdosta, GA
  • NPI 1144167545
  NPD (past)
• Eric G. Sutherland, PT, COMT

  • Physical Therapist
  • Valdosta, GA
  • NPI 1639262025
  NPD (past)
• Michelle Jennifer Sutherland, PT, PCS

  • Physical Therapist
  • Valdosta, GA
  • NPI 1306916416
  NPD (past)
• Martha S. Ward, M.D.

  • Internal Medicine Physician
  • Thomasville, GA
  • NPI 1871609248
  NPD (past)

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

{
    "created_epoch": "1418083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418083200000",
    "number": "1366840258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 GOOD HOPE CIR",
            "city": "NAYLOR",
            "state": "GA",
            "postal_code": "316413657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3328 BEMISS RD",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316057014",
            "telephone_number": "229-469-6137",
            "fax_number": "229-469-6139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALDOSTA HEALTH & WELLNESS CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-09",
        "last_updated": "2014-12-09",
        "status": "A",
        "authorized_official_last_name": "LIVINGSTON",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_middle_name": "Q",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "229-469-6137"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valdosta Family Dentistry
• Valdosta Family Medicine Associates, P.C.
• Valdosta Foot & Ankle Clinic, P.C.
• Valdosta Foot & Ankle Surgery Center, P.C.
• Valdosta Gastroenterology Associates, LLC
• Valdosta Healthcare Club
• Valdosta Imaging Center Inc
• Valdosta Kidney Clinic, LLC
• Valdosta Medical Associates
• Valdosta Medical Clinic

• All providers in Valdosta, GA
• Adult Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2014; 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.