NPIMap

Organization Active NPI

Urological Clinic of Valdosta PC

  • Specialist
  • Valdosta, GA
National Provider Identifier
1649491606
Registry record updated Jul 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
018627 Issued in GA
Legal business name
UROLOGICAL CLINIC OF VALDOSTA PC
Practice address
3294 North Oak St. Ext.
Valdosta, GA 31605
Phone
(229) 241-1188
Fax
(229) 245-7106
NPI assigned
May 1, 2007
Last updated
Jul 5, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2017

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

Authorized official

Name
Mr. Mike Syru Chiang, MD.NPI 1720063100
Title
Doctor
Phone
(229) 241-1188

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 18627 GA
Specialist 174400000X 018627 GA Primary

Addresses

Primary practice location

3294 North Oak St. Ext.
Valdosta, GA 31605

Mailing address

3294 North Oak St. Ext.
Valdosta, GA 31605
Phone (229) 241-1188

Other identifiers 2

IdentifierTypeStateIssuer
340005901OtherMEDICARE RAILROAD
000244791BMedicaidGA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1499212800000",
    "number": "1649491606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3294 NORTH OAK ST. EXT.",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "31605",
            "telephone_number": "229-241-1188",
            "fax_number": "229-245-7106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3294 NORTH OAK ST. EXT.",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "31605",
            "telephone_number": "229-241-1188",
            "fax_number": "229-245-7106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UROLOGICAL CLINIC OF VALDOSTA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-01",
        "last_updated": "2017-07-05",
        "status": "A",
        "authorized_official_last_name": "CHIANG",
        "authorized_official_first_name": "MIKE",
        "authorized_official_middle_name": "SYRU",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "229-241-1188",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "18627",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "018627",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "340005901",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000244791B",
            "state": "GA"
        }
    ],
    "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 Jul 5, 2017; 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.