| 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 | Eleanor M Beason | 
|---|---|
| Provider Type | Practitioner - Clinical Social Worker | 
| Provider Identifiers | NPI Number: 1114240272 PECOS PAC ID: 4587552807 Enrollment ID: I20040309000133 | 
| Provider Name | Clifford R Seward | 
|---|---|
| Provider Type | Practitioner - Ophthalmology | 
| Provider Identifiers | NPI Number: 1982673851 PECOS PAC ID: 4486646205 Enrollment ID: I20040402000062 | 
| 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 | Eugene Harris | 
|---|---|
| Provider Type | Practitioner - Emergency Medicine | 
| Provider Identifiers | NPI Number: 1235344367 PECOS PAC ID: 2062513443 Enrollment ID: I20070730000481 | 
| Provider Name | Tracy Snowden | 
|---|---|
| Provider Type | Practitioner - Optometry | 
| Provider Identifiers | NPI Number: 1679699680 PECOS PAC ID: 7719020080 Enrollment ID: I20100209000274 | 
| Provider Name | Rickey Harton | 
|---|---|
| Provider Type | Practitioner - Optometry | 
| Provider Identifiers | NPI Number: 1609861129 PECOS PAC ID: 6507881117 Enrollment ID: I20111101000443 | 
| 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 | Tanell Twanna Johnson | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1306355425 PECOS PAC ID: 1052679057 Enrollment ID: I20171221000426 | 
| 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 | Joseph Isagba | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1609488147 PECOS PAC ID: 9133539885 Enrollment ID: I20201109000346 | 
| Provider Name | Evelyn Roberts | 
|---|---|
| Provider Type | Practitioner - Clinical Social Worker | 
| Provider Identifiers | NPI Number: 1902264294 PECOS PAC ID: 4486050150 Enrollment ID: I20210903000505 | 
| Provider Name | Joseph Pruitt | 
|---|---|
| Provider Type | Practitioner - Optometry | 
| Provider Identifiers | NPI Number: 1477752913 PECOS PAC ID: 8921187477 Enrollment ID: I20230320002083 | 
| Provider Name | Al'tiana Manning | 
|---|---|
| Provider Type | Practitioner - Optometry | 
| Provider Identifiers | NPI Number: 1821615873 PECOS PAC ID: 5092103408 Enrollment ID: I20240209000827 | 
| Provider Name | Todd Smith | 
|---|---|
| Provider Type | Practitioner - Optometry | 
| Provider Identifiers | NPI Number: 1831202076 PECOS PAC ID: 5597785790 Enrollment ID: I20240313001334 | 
| Provider Name | Sarah Wang | 
|---|---|
| Provider Type | Practitioner - Optometry | 
| Provider Identifiers | NPI Number: 1083832638 PECOS PAC ID: 4587652789 Enrollment ID: I20240425003592 | 
| Provider Name | Katyana Samone Martin | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1407448723 PECOS PAC ID: 0648612762 Enrollment ID: I20240521002743 | 
| Provider Name | Ricardy Noncirel | 
|---|---|
| Provider Type | Practitioner - Family Practice | 
| Provider Identifiers | NPI Number: 1922873009 PECOS PAC ID: 0840632170 Enrollment ID: I20240531001291 | 
| Provider Name | Christina Battafarano | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1679124259 PECOS PAC ID: 4082073770 Enrollment ID: I20240624003704 | 
| Provider Name | Jillian Walker | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1093273872 PECOS PAC ID: 1254721327 Enrollment ID: I20240628002378 | 
| Provider Name | Jenna Tillett | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1023581436 PECOS PAC ID: 6901137066 Enrollment ID: I20240628002391 | 
| Provider Name | Jennifer Vinalon | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1033593322 PECOS PAC ID: 1153626866 Enrollment ID: I20240628002713 | 
| Provider Name | Breana Mackey | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1699147397 PECOS PAC ID: 8729388723 Enrollment ID: I20240722003282 | 
| Provider Name | Helene Clayton Jeter | 
|---|---|
| Provider Type | Practitioner - Optometry | 
| Provider Identifiers | NPI Number: 1306914726 PECOS PAC ID: 8224361696 Enrollment ID: I20240801000331 | 
| Provider Name | Rita De Palma | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1023594074 PECOS PAC ID: 6002160546 Enrollment ID: I20240809003487 | 
| Provider Name | Leigh Ann Yaughn | 
|---|---|
| Provider Type | Practitioner - Other (non-physician) | 
| Provider Identifiers | NPI Number: 1336690643 PECOS PAC ID: 9234660945 Enrollment ID: I20241006000036 | 
| Provider Name | Christine Hajduk | 
|---|---|
| Provider Type | Practitioner - Optometry | 
| Provider Identifiers | NPI Number: 1245301191 PECOS PAC ID: 7517918303 Enrollment ID: I20241023004931 | 
| Provider Name | Terri-ann Echague | 
|---|---|
| Provider Type | Practitioner - Optometry | 
| Provider Identifiers | NPI Number: 1952557555 PECOS PAC ID: 2567520661 Enrollment ID: I20241122001459 |