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General NPI Number Information
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NPI Number | 1437011624
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Entity Type | Organization
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Legal Business Name | SOUTH GEORGIA MENTAL HEALTHCARE, LLC
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Dates
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Enumeration Date | 11/26/2025
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 302 S GRANT ST
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City | FITZGERALD
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State | GA
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Zip | 31750-2914
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Country | US
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Telephone | 229-392-9000
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Fax | 478-210-1009
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Provider Business Mailing Address
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Address Line | 302 S GRANT ST
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City | FITZGERALD
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State | GA
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Zip | 31750-2914
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Country | US
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Telephone | 229-392-9000
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Fax | 478-210-1009
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Authorized Official
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Title or Position | OWNER/LPC
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Name | MS. PEGGY JANE HOGAN
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Credential | M.A., L.P.C.
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Telephone | 229-392-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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