NPIMap

Organization Active NPI

Southwell Ambulatory Inc

  • Family Medicine Physician
  • Valdosta, GA
National Provider Identifier
1497330625
Registry record updated Oct 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SOUTHWELL AMBULATORY INC
Practice address
2922 N Oak St Ste C
Valdosta, GA 31602-1885
Phone
(229) 262-6819
NPI assigned
Mar 9, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2022

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary
Primary Care Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP2300X

Addresses

Primary practice location

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

Mailing address

410 Connell Rd
Valdosta, GA 31602-1898
Phone (229) 353-6889

Other names 1

  • Southwell Primary Care Doing business as

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.

NPI Registry JSON

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

{
    "created_epoch": "1615248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666051200000",
    "number": "1497330625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 CONNELL RD",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021898",
            "telephone_number": "229-353-6889",
            "fax_number": "229-219-1631"
        },
        {
            "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": "229-262-6819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWELL AMBULATORY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-09",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-18",
        "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": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southwell Primary Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southwell Primary Care",
            "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 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.