Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ethereal Diagnostics & Services LLC

Organization Health Service Clinic/Center · NPI 1629822259

Ethereal Diagnostics & Services LLC is a Health Service Clinic/Center in Valdosta, Georgia. Registered with an NPI since 2024.

In the registry since
2024
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

100 N Patterson St Ste A
Valdosta, GA 31601-5570
Phone: (877) 586-2971
Fax: (866) 703-1440
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Health Service Clinic/Center (primary) Taxonomy 261QH0100X

Record details

NPI number1629822259
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Porsha Robinson — Ceo · (877) 586-2971
NPI enumeratedApril 11, 2024
Last updated in NPPESApril 11, 2024
Certification dateApril 11, 2024
Mailing address1 Grand Park Ln Apt 3119, Thomasville, GA 31757-4909

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