| NPI | LastName | FirstName | MidName | Organization | Mailing Address | City | State | Zip |
| 1841452505 | CLARK | MICHAEL | ALLEN | 3527 N VALDOSTA RD | VALDOSTA | GA | 316026418 | |
| 1891035663 | HERMANSEN | DAVID | SEAN | 3527 N VALDOSTA RD | VALDOSTA | GA | 316026418 | |
| 1124280862 | LANE | PAUL | DOLPHOUS | 3527 N VALDOSTA RD | VALDOSTA | GA | 316026418 |