Healthcare Provider Details

I. General information

NPI: 1528049046
Provider Name (Legal Business Name): SOUTH GEORGIA MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 09/02/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N PATTERSON ST
VALDOSTA GA
31602-1735
US

IV. Provider business mailing address

PO BOX 1805
VALDOSTA GA
31603-1805
US

V. Phone/Fax

Practice location:
  • Phone: 229-249-4144
  • Fax: 229-249-4145
Mailing address:
  • Phone: 229-433-7150
  • Fax: 229-433-8416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number008065
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JULIE W HODGES
Title or Position: CONTROLLER
Credential:
Phone: 229-259-4140