MEDICARE: SOUTH GEORGIA MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	PHRE006396	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PHRE006396	OTHER	GA	PHARMACY LICENSE #

General Provider Information

NPI Number	:	1831171867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH GEORGIA MEDICAL CENTER

Provider Business Mailing Address
First Line	:	2501 NORTH PATTERSON STREET
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31603-1727
Country	:	US
Telephone Number	:	229-259-4869
Fax Number	:	229-259-4872

Provider Business Practice Location Address
First Line	:	2501 NORTH PATTERSON STREET
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31603-1727
Country	:	US
Telephone Number	:	229-259-4869
Fax Number	:	229-259-4872

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY
Name	:	MR. WILLIAM M. BRANNEN
Credential	:	R.PH.
Telephone Number	:	229-259-4869

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	03/07/2023

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Directions to “SOUTH GEORGIA MEDICAL CENTER ” Practice Location

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