VALDOSTA CHILDREN'S HEALTHCARE CENTER ,LLC - NPI 1407864770

Q: What is the provider's specialty?

The provider's specialty is Pediatrics with taxonomy code 2080A0000X and a focus in Adolescent Medicine.

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About Valdosta Children's Healthcare Center ,llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

VALDOSTA CHILDREN'S HEALTHCARE CENTER ,LLC (NPI 1407864770) is a healthcare organization registered as an adolescent medicine in Valdosta, Georgia and active in the NPI registry since August 2006. The organization holds a CLIA Waiver certificate valid through October 19, 2026 and lists Jasbir S Gill, President, as its authorized official.

NPPES Registry Identity

NPI1407864770

Entity TypeOrganization

Primary Taxonomy2080A0000X

Legal Business NameVALDOSTA CHILDREN'S HEALTHCARE CENTER ,LLC

Location Address105 W CRANFORD AVEValdosta, GA 31602-2930

Mailing Address105 W Cranford AveValdosta, GA 31602-2930 · (229) 247-7350 · Fax (229) 242-1730

Phone(229) 247-7350

Fax(229) 242-1730

Organization SubpartNo

Authorized OfficialJasbir S GillPresident · (229) 247-7350

Enumeration DateAugust 3, 2006

Last NPPES UpdateSeptember 6, 2011

✔ NPI 1407864770 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatrics · Adolescent MedicineAllopathic & Osteopathic Physicians

Taxonomy Code2080A0000X

Definition

A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.

105 W CRANFORD AVE, Valdosta, GA 31602

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D0877215

Valdosta Children's Healthcare · Valdosta, GA

Active · expires Oct 19, 2026

CLIA Number11D0877215

Laboratory TypePhysician Office

Certificate Effective DateOctober 20, 2024

Certificate Expiration DateOctober 19, 2026

Laboratory DirectorCheryl L. Tolliver

Laboratory Phone(229) 247-7350

Laboratory LocationValdosta Children's Healthcare105 West Cranford Avenue, Valdosta, GA 31602

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JASBIR S GILL M.D

Pediatrics (Adolescent Medicine)