| Valley Healthcare System Inc | |
|
94 Mccrary Road Fortson GA 31808 | |
| (706) 987-8216 | |
| (706) 987-8220 |
| Full Name | Valley Healthcare System Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 94 Mccrary Road, Fortson, Georgia |
| Authorized Official Name and Position | Sarah E Lang (CHEIF EXECUTIVE OFFICER) |
| Authorized Official Contact | 7063229599 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Valley Healthcare System Inc 1600 Fort Benning Rd Columbus GA 31903-2834 Ph: (706) 322-9599 | Valley Healthcare System Inc 94 Mccrary Road Fortson GA 31808 Ph: (706) 987-8216 |
| NPI Number | 1952599623 |
|---|---|
| Provider Enumeration Date | 10/09/2007 |
| Last Update Date | 07/02/2018 |
| Medicare PECOS PAC ID | 8628988276 |
|---|---|
| Medicare Enrollment ID | O20040528000880 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952599623 | NPI | - | NPPES |
| 202G702049 | Other | GA | MEDICARE PTAN |
| 000617196K | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Brel Clark |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1619075033 PECOS PAC ID: 0143201715 Enrollment ID: I20040917000769 |
| Provider Name | Kimberly B Brown-gullatt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902836000 PECOS PAC ID: 1456356807 Enrollment ID: I20060919000260 |
| Provider Name | Giovanna Guerra Troche |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1265741771 PECOS PAC ID: 8123345618 Enrollment ID: I20150320002004 |
| Provider Name | Takaya L Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285016626 PECOS PAC ID: 7719293844 Enrollment ID: I20150903000669 |
| Provider Name | Frances N Uneanya |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205491362 PECOS PAC ID: 4880025733 Enrollment ID: I20200511000921 |
| Provider Name | Tanesh L Buckner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376929943 PECOS PAC ID: 1456773100 Enrollment ID: I20200625000886 |
| Provider Name | Evelyn Roberts |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902264294 PECOS PAC ID: 4486050150 Enrollment ID: I20210903000505 |
| Provider Name | Katyana Samone Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407448723 PECOS PAC ID: 0648612762 Enrollment ID: I20240521002743 |