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General NPI Number Information
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NPI Number | 1528126182
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Entity Type | Organization
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Legal Business Name | SOUTH GEORGIA MEDICINE, P.C.
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 06/21/2021
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Provider Practice Location Address
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Address Line | 1111 20TH ST E
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City | TIFTON
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State | GA
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Zip | 31794-3689
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Country | US
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Telephone | 229-382-9338
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Fax | 229-382-4282
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Provider Business Mailing Address
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Address Line | 1111 20TH ST E
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City | TIFTON
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State | GA
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Zip | 31794-3689
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Country | US
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Telephone | 229-382-9338
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Fax | 229-382-4282
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | SHIRLEY VICKERS CARRINGTON
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Credential |
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Telephone | 229-382-9338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 021582
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License Number State | GA
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