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General NPI Number Information
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NPI Number | 1215727193
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Entity Type | Organization
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Legal Business Name | SGMC AFFILIATED SERVICES LLC
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Dates
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Enumeration Date | 05/12/2025
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 2501 N PATTERSON ST
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City | VALDOSTA
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State | GA
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Zip | 31602-1735
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Country | US
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Telephone | 229-433-1000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9
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City | VALDOSTA
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State | GA
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Zip | 31603-0009
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | JOHN MOORE
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Credential |
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Telephone | 229-259-4162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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