Healthcare Provider Details

I. General information

NPI: 1295918712
Provider Name (Legal Business Name): SOUTH GA ORTHOPEDIC RESOURCES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 OLD OCILLA RD
TIFTON GA
31794-1617
US

IV. Provider business mailing address

1825 OLD OCILLA RD
TIFTON GA
31794-1617
US

V. Phone/Fax

Practice location:
  • Phone: 229-386-9829
  • Fax: 229-386-9830
Mailing address:
  • Phone: 229-386-9829
  • Fax: 229-386-9830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFERY DEAN PARSON
Title or Position: OWNER, ORTHOTIST
Credential: CO
Phone: 229-386-9829