| Greenleaf Center | |
|
2209 Pineview Dr Valdosta GA 31602-7316 | |
| (229) 247-4357 | |
| (229) 244-6194 |
| Full Name | Greenleaf Center |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 2209 Pineview Dr, Valdosta, Georgia |
| Authorized Official Name and Position | Greg S Hembree (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 2292594160 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Greenleaf Center Po Box 0070 Attn: Pfs Dept Valdosta GA 31603-0070 Ph: (229) 247-4357 | Greenleaf Center 2209 Pineview Dr Valdosta GA 31602-7316 Ph: (229) 247-4357 |
| NPI Number | 1033160791 |
|---|---|
| Provider Enumeration Date | 05/15/2006 |
| Last Update Date | 05/09/2011 |
| Medicare PECOS PAC ID | 1355334509 |
|---|---|
| Medicare Enrollment ID | O20040405001313 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033160791 | NPI | - | NPPES |
| HOSP24 | Other | GA | CAHABA |
| 00001724A | Medicaid | GA |
| Provider Name | Madalyn N Davidoff |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1912909201 PECOS PAC ID: 1456255082 Enrollment ID: I20031125000000 |
| Provider Name | Leslie R. Holmes |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1598788721 PECOS PAC ID: 9133013626 Enrollment ID: I20040216000073 |
| Provider Name | Jennifer E Lawrence |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1396827457 PECOS PAC ID: 2769470400 Enrollment ID: I20040503000973 |
| Provider Name | Joe H Johnson |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1326082033 PECOS PAC ID: 8022919505 Enrollment ID: I20040622000832 |
| Provider Name | Randall B Brown |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1124062831 PECOS PAC ID: 2668373143 Enrollment ID: I20040622001088 |
| Provider Name | Joseph M Trasmonte |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194708487 PECOS PAC ID: 1850353426 Enrollment ID: I20041102000374 |
| Provider Name | Glenn H Evans |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1285623744 PECOS PAC ID: 1759339781 Enrollment ID: I20050106000622 |
| Provider Name | Kathleen S Johnson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1104819689 PECOS PAC ID: 1658322599 Enrollment ID: I20050208000579 |
| Provider Name | Bennett P Hogan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205891397 PECOS PAC ID: 2769434794 Enrollment ID: I20050217000468 |
| Provider Name | Thomas Hilton |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1316949746 PECOS PAC ID: 9032003454 Enrollment ID: I20050802000927 |
| Provider Name | Tana M Macera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306985619 PECOS PAC ID: 7416986401 Enrollment ID: I20050810000492 |
| Provider Name | Rebecca S Tarlton |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1083655393 PECOS PAC ID: 4981624061 Enrollment ID: I20051205000329 |
| Provider Name | Harsh Singh |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1801888433 PECOS PAC ID: 3971582149 Enrollment ID: I20060629000271 |
| Provider Name | William Nash |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235172628 PECOS PAC ID: 6204729619 Enrollment ID: I20060720000227 |
| Provider Name | Wendy Vandemark |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386698231 PECOS PAC ID: 2264491554 Enrollment ID: I20060802000052 |
| Provider Name | John D Anderson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316947484 PECOS PAC ID: 0345341921 Enrollment ID: I20070726000417 |
| Provider Name | Brian C Griner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366470650 PECOS PAC ID: 2163514175 Enrollment ID: I20070906000041 |
| Provider Name | Joel L Cohen |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1841265717 PECOS PAC ID: 2264480334 Enrollment ID: I20080502000002 |
| Provider Name | Larry E Smith |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548297195 PECOS PAC ID: 7416038070 Enrollment ID: I20080707000340 |
| Provider Name | Vithal Kusuma |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1750375051 PECOS PAC ID: 9436053774 Enrollment ID: I20090122000674 |
| Provider Name | Samuel N Ofori |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1548285703 PECOS PAC ID: 7012061088 Enrollment ID: I20090811000413 |
| Provider Name | Steven B Dawson |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1578605259 PECOS PAC ID: 9537178348 Enrollment ID: I20100514000836 |
| Provider Name | Bonni Cohen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861535296 PECOS PAC ID: 6901902923 Enrollment ID: I20100521000310 |
| Provider Name | David Keith Parker |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1306819040 PECOS PAC ID: 3779627369 Enrollment ID: I20100712000017 |
| Provider Name | George S Staton |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1215990098 PECOS PAC ID: 4587796404 Enrollment ID: I20100713000194 |
| Provider Name | John Kendrick |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1164426136 PECOS PAC ID: 0345132197 Enrollment ID: I20100826000683 |
| Provider Name | George Patton Pennington |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1669471926 PECOS PAC ID: 3476678749 Enrollment ID: I20100910000548 |
| Provider Name | Steven Bobby Ellison |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1992724769 PECOS PAC ID: 9830214311 Enrollment ID: I20100921000969 |
| Provider Name | Vipul Parekh |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1831416304 PECOS PAC ID: 0547452898 Enrollment ID: I20101006000016 |
| Provider Name | Gregory S Beale |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1497782817 PECOS PAC ID: 3870674435 Enrollment ID: I20101103000760 |
| Provider Name | Lynn S Lee |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548298839 PECOS PAC ID: 7315028974 Enrollment ID: I20101103000995 |
| Provider Name | William Davie Lyday |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1134103195 PECOS PAC ID: 7911042262 Enrollment ID: I20101124000153 |
| Provider Name | Pamela W Powell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184805400 PECOS PAC ID: 0143304741 Enrollment ID: I20110923000184 |
| Provider Name | Thomas E Young |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1083694665 PECOS PAC ID: 3072558683 Enrollment ID: I20120105000480 |
| Provider Name | Jennifer A Stevick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265700595 PECOS PAC ID: 6305006362 Enrollment ID: I20120328000822 |
| Provider Name | Lisa K Weldon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538470851 PECOS PAC ID: 2466616719 Enrollment ID: I20120618000137 |
| Provider Name | Marie-carmelle Elie |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1114958527 PECOS PAC ID: 2163475781 Enrollment ID: I20120620000089 |
| Provider Name | Matthew Christopher Smith |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1861482390 PECOS PAC ID: 6507027505 Enrollment ID: I20120829000405 |
| Provider Name | Venkatesan R Gorantla |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1659302891 PECOS PAC ID: 7618911579 Enrollment ID: I20121121000207 |
| Provider Name | Tambrea T Ellison |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1306005202 PECOS PAC ID: 6507016243 Enrollment ID: I20130624000446 |
| Provider Name | William Douglas Luke |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1326250036 PECOS PAC ID: 5698915569 Enrollment ID: I20130717000661 |
| Provider Name | Azif Safarulla |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1477702504 PECOS PAC ID: 7214150473 Enrollment ID: I20140516000441 |
| Provider Name | Susan B Howell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518396795 PECOS PAC ID: 3971723230 Enrollment ID: I20141008001981 |
| Provider Name | Michael O Nwaneri |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1073788444 PECOS PAC ID: 2365604709 Enrollment ID: I20150317001653 |
| Provider Name | Kelly Blackmon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992110688 PECOS PAC ID: 3072830058 Enrollment ID: I20150401001028 |
| Provider Name | Dakshaben P Coleman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467793000 PECOS PAC ID: 4183936107 Enrollment ID: I20150706001481 |
| Provider Name | David M Hardy |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1548467939 PECOS PAC ID: 7517105299 Enrollment ID: I20150902000673 |
| Provider Name | Kaitlyn E Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811368939 PECOS PAC ID: 0749590289 Enrollment ID: I20151112001326 |
| Provider Name | Govindarajan Venkatesh |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1356317648 PECOS PAC ID: 1951599299 Enrollment ID: I20160125001857 |
| Provider Name | Brandy Faircloth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669838272 PECOS PAC ID: 8426352378 Enrollment ID: I20160212001479 |
| Provider Name | Michael C Ibe |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1215291026 PECOS PAC ID: 1254570856 Enrollment ID: I20160223000991 |
| Provider Name | Peter K Meyers |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1437162716 PECOS PAC ID: 1658368725 Enrollment ID: I20160426000397 |
| Provider Name | Mukhtar Anees |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1073714200 PECOS PAC ID: 2860463460 Enrollment ID: I20160728000796 |
| Provider Name | Roxana Coman |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1568616498 PECOS PAC ID: 7719159284 Enrollment ID: I20160728001780 |
| Provider Name | Gretchen Anderson |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1811286297 PECOS PAC ID: 2961795703 Enrollment ID: I20160801001693 |
| Provider Name | Jana D Harrod |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477900355 PECOS PAC ID: 3779877121 Enrollment ID: I20160808000638 |
| Provider Name | Leslie Lamptey |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1508208232 PECOS PAC ID: 2860786258 Enrollment ID: I20160808002144 |
| Provider Name | Corne Maydell |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1396901591 PECOS PAC ID: 7113215823 Enrollment ID: I20161012002931 |
| Provider Name | Julene D Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083071898 PECOS PAC ID: 6406134238 Enrollment ID: I20161031000790 |
| Provider Name | Ramon Caballero |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1851480453 PECOS PAC ID: 6901798263 Enrollment ID: I20161121002128 |
| Provider Name | Kimberlee Fletcher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962944728 PECOS PAC ID: 9234411653 Enrollment ID: I20170119002809 |
| Provider Name | Bernard J Wortman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386181238 PECOS PAC ID: 5092084145 Enrollment ID: I20170705000613 |
| Provider Name | Savita Bidyasar |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1326242926 PECOS PAC ID: 7719126853 Enrollment ID: I20170705001146 |
| Provider Name | Adegboyega O Aderibigbe |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1912960048 PECOS PAC ID: 0941593800 Enrollment ID: I20170804002180 |
| Provider Name | James Shoptaw Jr. |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1710951942 PECOS PAC ID: 3678543089 Enrollment ID: I20170822002228 |
| Provider Name | Babatunde T Sobowale |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1740441948 PECOS PAC ID: 8729266796 Enrollment ID: I20170828003482 |
| Provider Name | Ibrahim Usman-oyowe |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1255695136 PECOS PAC ID: 7517274889 Enrollment ID: I20170908002217 |
| Provider Name | Marcus Cox |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1922298868 PECOS PAC ID: 4486626249 Enrollment ID: I20171006002778 |
| Provider Name | Jianfeng Wang |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1922395664 PECOS PAC ID: 0648545004 Enrollment ID: I20171011000677 |
| Provider Name | Warren Carrigan Iii |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1326282153 PECOS PAC ID: 2466690847 Enrollment ID: I20171023001265 |
| Provider Name | Lila L Bennett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932620598 PECOS PAC ID: 5991061400 Enrollment ID: I20171115002335 |
| Provider Name | Shelby L Elder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205333424 PECOS PAC ID: 4183973357 Enrollment ID: I20180821002553 |
| Provider Name | Bryant Nguyen |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1902085426 PECOS PAC ID: 4789756545 Enrollment ID: I20180921001657 |
| Provider Name | Des R Bharti |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1932192275 PECOS PAC ID: 3779653829 Enrollment ID: I20181018003044 |
| Provider Name | Sarah R. Colson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669734158 PECOS PAC ID: 7315284825 Enrollment ID: I20190122002667 |
| Provider Name | Seth A Courson |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1952763302 PECOS PAC ID: 0446544928 Enrollment ID: I20190912000497 |
| Provider Name | Philip A Cooper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588149819 PECOS PAC ID: 7810227568 Enrollment ID: I20190924001827 |
| Provider Name | Ashley Marie Robertson |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1578900858 PECOS PAC ID: 2668790940 Enrollment ID: I20191105003070 |
| Provider Name | Syed Askari Hasan |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1992157812 PECOS PAC ID: 0941562003 Enrollment ID: I20191108000200 |
| Provider Name | Anand Subhash Shah |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1073870358 PECOS PAC ID: 4880940022 Enrollment ID: I20191114003114 |
| Provider Name | Magdy N Falestiny |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942421581 PECOS PAC ID: 8527954122 Enrollment ID: I20200421000965 |
| Provider Name | Chad Wesley Eisenhart |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1306473400 PECOS PAC ID: 9931539392 Enrollment ID: I20200427000409 |
| Provider Name | Kenneth Jackson Delay |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1699092056 PECOS PAC ID: 5890082945 Enrollment ID: I20200813000299 |
| Provider Name | Matthew Nijem Varn |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1316370851 PECOS PAC ID: 1951652403 Enrollment ID: I20200909000846 |
| Provider Name | Megan Leigh Gallagher |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1699015438 PECOS PAC ID: 1951696269 Enrollment ID: I20201130002569 |
| Provider Name | Barney Beaver |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1609870450 PECOS PAC ID: 5496653552 Enrollment ID: I20210104001994 |
| Provider Name | Mi Hyun Choi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760075030 PECOS PAC ID: 3678988680 Enrollment ID: I20210224000856 |
| Provider Name | Joseph D Hayes |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952806846 PECOS PAC ID: 2062764939 Enrollment ID: I20210615002905 |
| Provider Name | Erwinson Barnatchea Bassig |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1871796664 PECOS PAC ID: 3577966514 Enrollment ID: I20210728001282 |
| Provider Name | Jack Owens |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1609952241 PECOS PAC ID: 5597168427 Enrollment ID: I20210729000901 |
| Provider Name | Swapna Narayana Rao Gari |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1891958021 PECOS PAC ID: 8022169564 Enrollment ID: I20210816000108 |
| Provider Name | Meredith Emily Decesare |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104382092 PECOS PAC ID: 0749678951 Enrollment ID: I20211020002025 |
| Provider Name | Eli Metts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699345017 PECOS PAC ID: 9739577248 Enrollment ID: I20211102000891 |
| Provider Name | Salah Elsaharty |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1982625224 PECOS PAC ID: 3072581800 Enrollment ID: I20220503002776 |
| Provider Name | Christopher Nobo |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1407167919 PECOS PAC ID: 0547570343 Enrollment ID: I20220505001011 |
| Provider Name | Saif Munther Za'al Al Borgan |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1346762606 PECOS PAC ID: 4486085057 Enrollment ID: I20220617000038 |
| Provider Name | Nicole A Wagaman |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1689011405 PECOS PAC ID: 8820229222 Enrollment ID: I20220629001747 |
| Provider Name | Timothy I Sobukonla |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1134689771 PECOS PAC ID: 5092196410 Enrollment ID: I20220718000627 |
| Provider Name | Khwaja Fahad Haq |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1316349038 PECOS PAC ID: 0345641882 Enrollment ID: I20220809003299 |
| Provider Name | Ibrahim Abubakar |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1215382676 PECOS PAC ID: 5496046518 Enrollment ID: I20220912003915 |
| Provider Name | Aileen Catherine Cangiano-heath |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1609074616 PECOS PAC ID: 9234544735 Enrollment ID: I20221010001201 |
| Provider Name | Alexander J Eason |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1306229182 PECOS PAC ID: 5395111561 Enrollment ID: I20221013002350 |
| Provider Name | Jennifer Palarczyk |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1629395199 PECOS PAC ID: 8325302573 Enrollment ID: I20221102001631 |
| Provider Name | Imtiaz Alam |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1619064284 PECOS PAC ID: 7416932371 Enrollment ID: I20221107002398 |
| Provider Name | Amit B Mori |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1053548891 PECOS PAC ID: 7719135706 Enrollment ID: I20221130002357 |
| Provider Name | Jing Wang |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1386080091 PECOS PAC ID: 8123256112 Enrollment ID: I20221228003084 |
| Provider Name | Richard Bias |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518595339 PECOS PAC ID: 0143645325 Enrollment ID: I20230125001505 |
| Provider Name | Eileen Deano |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1558527069 PECOS PAC ID: 1456418144 Enrollment ID: I20230313002985 |
| Provider Name | Gregory Downing |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1285656454 PECOS PAC ID: 5991129025 Enrollment ID: I20230327000235 |
| Provider Name | Prashant Rai |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1770993339 PECOS PAC ID: 8224363098 Enrollment ID: I20230327000803 |
| Provider Name | Caroline Smitha Comparato |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740970649 PECOS PAC ID: 9739546888 Enrollment ID: I20230605001483 |
| Provider Name | Hetain N Patel |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1710227954 PECOS PAC ID: 2365735602 Enrollment ID: I20230725001124 |
| Provider Name | Nieka Harris |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1396825618 PECOS PAC ID: 0547408395 Enrollment ID: I20230907000066 |
| Provider Name | Jose Nieto |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1225190002 PECOS PAC ID: 2365498664 Enrollment ID: I20230915000381 |
| Provider Name | Abhishek Lunagariya |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1336582030 PECOS PAC ID: 2961629753 Enrollment ID: I20231227002430 |
| Provider Name | Cameron John Elward |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1538627005 PECOS PAC ID: 2668824129 Enrollment ID: I20240119002791 |
| Provider Name | Abimbola Odusanya |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1689660151 PECOS PAC ID: 3274516463 Enrollment ID: I20240119003242 |
| Provider Name | Brittany Andry |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1104115567 PECOS PAC ID: 3072733260 Enrollment ID: I20240214003451 |
| Provider Name | Meshva Akwalia |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1003266073 PECOS PAC ID: 5496009557 Enrollment ID: I20240321002396 |
| Provider Name | Jennifer Carbone |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1033504600 PECOS PAC ID: 2567802119 Enrollment ID: I20240430000332 |
| Provider Name | Alireza Showraki |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1215597398 PECOS PAC ID: 8123353604 Enrollment ID: I20240612002428 |
Lynze Vickers, Lmft, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3350 Noble Way, Suite B, Valdosta, GA 31605 Phone: 229-333-0300 | |
Renewed Mind Counseling Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2109 N Patterson St Ste B, Valdosta, GA 31602 Phone: 229-232-4833 Fax: 877-343-0538 | |
Southern Neurology, Physical Medicine & Rehabilitation, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4913 Lanes Pond Rd, Valdosta, GA 31601 Phone: 229-292-2074 | |
Megan Tillman Lmft Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3310 Bemiss Rd, Valdosta, GA 31605 Phone: 229-586-6082 | |
The Healing Touch Counseling Center, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4072 Mulligan Rd, Valdosta, GA 31605 Phone: 229-356-7190 | |
Cazales Autism Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2704 N Oak St Bldg A1, Valdosta, GA 31602 Phone: 203-606-1676 Fax: 229-598-0557 |