NPIMap

Organization Active NPI

Destiny Medical Services, Inc

  • Physical Medicine & Rehabilitation Physician
  • Valdosta, GA
National Provider Identifier
1508293465
Registry record updated Oct 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
41426 Issued in GA
Legal business name
DESTINY MEDICAL SERVICES, INC
Practice address
2804 N Oak St
Valdosta, GA 31602-5914
Phone
(229) 241-8925
Fax
(229) 241-9165
NPI assigned
Oct 8, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2013

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

Authorized official

Name
Dr. Stacey Willingham
Title
Ceo'
Phone
(404) 964-1474

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208100000X 41426 GA Primary

Addresses

Primary practice location

2804 N Oak St
Valdosta, GA 31602-5914

Mailing address

2774 N Cobb Pkwy
Suite 109, #133
Kennesaw, GA 30152-3469

National Provider Directory

National Provider Directory

Locations

2804 N Oak St
Valdosta, GA 31602
Phone (229) 241-8925

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1381190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381190400000",
    "number": "1508293465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2774 N COBB PKWY",
            "address_2": "SUITE 109, #133",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301523469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2804 N OAK ST",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316025914",
            "telephone_number": "229-241-8925",
            "fax_number": "229-241-9165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESTINY MEDICAL SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-08",
        "last_updated": "2013-10-08",
        "status": "A",
        "authorized_official_last_name": "WILLINGHAM",
        "authorized_official_first_name": "STACEY",
        "authorized_official_title_or_position": "CEO'",
        "authorized_official_telephone_number": "404-964-1474",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "GA",
            "license": "41426",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 8, 2013; 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.