{
"Npi": {
"NPI": "1922530468",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SOUTHEAST GEORGIA HEALTH SERVICES, L.L.C.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1900 TEBEAU ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WAYCROSS",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31501-6357",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "912-283-3030",
"MailingAddressFaxNumber": "912-287-2505",
"FirstLinePracticeLocationAddress": "1900 TEBEAU ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WAYCROSS",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "31501-6357",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "912-283-3030",
"PracticeLocationAddressFaxNumber": "912-287-2505",
"EnumerationDate": "04/03/2017",
"LastUpdateDate": "09/24/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "INGLETT",
"AuthorizedOfficialFirstName": "JUSTIN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CFO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "912-283-3030",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "282NR1301X",
"TaxonomyName": "Rural Acute Care Hospital",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}