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General NPI Number Information
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NPI Number | 1528049046
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Entity Type | Organization
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Legal Business Name | SOUTH GEORGIA MEDICAL CENTER INC
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 09/02/2025
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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 | 229-249-4144
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Fax | 229-249-4145
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Provider Business Mailing Address
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Address Line | PO BOX 1805
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City | VALDOSTA
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State | GA
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Zip | 31603-1805
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Country | US
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Telephone | 229-433-7150
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Fax | 229-433-8416
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Authorized Official
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Title or Position | CONTROLLER
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Name | JULIE W HODGES
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Credential |
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Telephone | 229-259-4140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 008065
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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