Healthcare Provider Details

I. General information

NPI: 1265935522
Provider Name (Legal Business Name): SOUTH GEORGIA HOSPITALIST SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 WATERS AVE STE F10
SAVANNAH GA
31406-3822
US

IV. Provider business mailing address

PO BOX 1067
STATESBORO GA
30459-1067
US

V. Phone/Fax

Practice location:
  • Phone: 912-764-2455
  • Fax: 912-764-7522
Mailing address:
  • Phone: 912-764-2455
  • Fax: 912-764-7522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID CASTLEBERRY
Title or Position: CEO
Credential:
Phone: 912-764-2455