Valdosta Medical Clinic

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

VALDOSTA MEDICAL CLINIC

Practice address

3207 Country Club Dr
Valdosta, GA 31605-1029

Phone

(229) 242-8480

Fax

(229) 241-0252

NPI assigned

Feb 9, 2007

Last updated

Jan 29, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Robin Bush, MANAGER

Title

Manager

Phone

(229) 242-8480

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

Interoperability endpoints

• Direct secure messaging: alyson.lerstang@valdostamed.gadirect.net
• Direct secure messaging: anthony.johnson@valdostamed.gadirect.net
• Direct secure messaging: kg.kumar@valdostamed.gadirect.net
• Direct secure messaging: landis.gordon@valdostamed.gadirect.net
• Direct secure messaging: thomas.hobby@valdostamed.gadirect.net

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jarod Franklin Bailey, D.O.

  • Internal Medicine Physician
  • Valdosta, GA
  • NPI 1649432733
  Medicare reassignment NPD
• Alford Timothy Brady, MD

  • Internal Medicine Physician
  • Valdosta, GA
  • NPI 1467449272
  Medicare reassignment NPD
• Glenn Hamilton Evans Sr., MD

  • Interventional Cardiology Physician
  • Douglas, GA
  • NPI 1285623744
  Medicare reassignment NPD
• Edward John Fricker, MD

  • Gastroenterology Physician
  • Valdosta, GA
  • NPI 1316933823
  Medicare reassignment NPD
• Thomas Warren Hobby, DO

  • Internal Medicine Physician
  • Valdosta, GA
  • NPI 1497749733
  Medicare reassignment NPD
• Susan B Howell, APRN

  • Family Nurse Practitioner
  • Valdosta, GA
  • NPI 1518396795
  Medicare reassignment NPD
• Anthony Wayne Johnson, MD

  • Family Medicine Physician
  • Valdosta, GA
  • NPI 1104186246
  Medicare reassignment NPD
• Fredrick Arthur Koehler, MD

  • Internal Medicine Physician
  • Nashville, GA
  • NPI 1255327797
  Medicare reassignment NPD
• Kesavan Gopa Kumar, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Valdosta, GA
  • NPI 1124016860
  Medicare reassignment NPD
• Hernando Moreno, MD

  • Internal Medicine Physician
  • Valdosta, GA
  • NPI 1396950994
  Medicare reassignment NPD
• George Edmund Powell III, MD

  • Cardiovascular Disease Physician
  • Brunswick, GA
  • NPI 1821072398
  Medicare reassignment NPD
• Jonathan Lance Underwood, MD

  • Internal Medicine Physician
  • Valdosta, GA
  • NPI 1265612972
  Medicare reassignment NPD

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422489600000",
    "number": "1538200035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3207 COUNTRY CLUB DR.",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "31605",
            "telephone_number": "229-242-8480",
            "fax_number": "229-242-0070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3207 COUNTRY CLUB DR",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316051029",
            "telephone_number": "229-242-8480",
            "fax_number": "229-241-0252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALDOSTA MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2015-01-29",
        "status": "A",
        "authorized_official_last_name": "BUSH",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "229-242-8480",
        "authorized_official_credential": "MANAGER"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valdosta Health & Wellness Clinic Inc
• Valdosta Healthcare Club
• Valdosta Imaging Center Inc
• Valdosta Kidney Clinic, LLC
• Valdosta Medical Associates
• Valdosta Oral and Maxillofacial Surgeons
• Valdosta Orthopedic Associates PC (Valdosta Orthopedic Associates)
• Valdosta Physical Therapy, Inc
• Valdosta Podiatry Associates, PC (North Oak Ambulatory Surgery Center)
• Valdosta Psychiatric Associates, LLC

• Multi-Specialty Clinic/Center in Valdosta, GA
• Providers in Valdosta, GA by specialty
• Multi-Specialty Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2015; 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.