SOUTH GEORGIA HEALTH GROUP, LLC (NPI# 1306091376) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306091376 |
| Entity Type | Organization |
| Organization Name | SOUTH GEORGIA HEALTH GROUP, LLC |
| Practice Address |
814 Northwood Park Dr Valdosta GA 31602-1398 |
| Practice Telephone | 2292590032 |
| Practice Fax Number | 2292590068 |
| Mailing Telephone | 2292590032 |
| Mailing Fax Number | 2292590068 |
| Enumeration Date | 2008-11-18 |
| Last Update Date | 2012-05-21 |
| Authorized Official Name | DOUGLAS MOSS (MEMBER) |
| Authorized Official Telephone | 2292590032 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians | ||
| N | 2086S0129X |
Surgery Specialization: Vascular Surgery |
Allopathic & Osteopathic Physicians | ||
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 789586476A | 05 |
| Street Address |
814 NORTHWOOD PARK DR |
| City | VALDOSTA |
| State | GA |
| Zip Code | 31602-1398 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679542781 | Douglas Moss | Emergency Medicine | 814 Northwood Park Dr, Valdosta, GA 31602-1398 | 2006-03-14 |
| 1720693047 | Southwell Ambulatory Inc | Obstetrics & Gynecology | 814 Northwood Park Dr, Valdosta, GA 31602-1398 | 2020-09-14 |
| 1609189943 | South Georgia Health Group LLC | Durable Medical Equipment & Medical Supplies | 814 Northwood Park Dr, Valdosta, GA 31602-1398 | 2010-07-15 |
| 1245484427 | Grant Nh LLC | Internal Medicine | 814 Northwood Park Dr, Valdosta, GA 31602-1398 | 2008-11-14 |
| 1518150838 | Tgs, LLC | Obstetrics & Gynecology | 814 Northwood Park Dr, Valdosta, GA 31602-1398 | 2007-08-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477198117 | Amber Michele Baugh | Behavior Technician | 2236 Bemiss Road, Valdosta, GA 31602 | 2019-11-15 |
| 1528611365 | Nishaben T. Patel | Nurse Practitioner | 3120 North Oak Street Extension, Suite B, Valdosta, GA 31602 | 2019-07-22 |
| 1427615871 | Blair Elizabeth Tomlinson | Nurse Practitioner | 2124 Lakeshore Drive, Valdosta, GA 31602 | 2019-05-21 |
| 1346704152 | Mildred Itaska Borowski | Counselor | 3790 North Highway 41, Suite A, Valdosta, GA 31602 | 2019-01-25 |
| 1962991703 | Southern Healthcare Alliance, LLC | Physical Medicine & Rehabilitation | 101-f W. Northside Drive, Valdosta, GA 31602 | 2018-05-08 |
| 1336636646 | Kaitlyn Thrift | Behavioral Analyst | 2225 Bemiss Road Suite D, Valdosta, GA 31602 | 2018-04-23 |
| 1407379845 | Lindsey Marie Richardson | Dentist | 103 W. Cranford Ave, Valdosta, GA 31602 | 2017-07-18 |
| 1962922427 | Taylor Nicole Fiveash | Nurse Practitioner | 101 W Northisde Dr, Bldg G, Valdosta, GA 31602 | 2017-06-26 |
| 1720520646 | Southern Sleepers Anesthesia LLC | Nurse Anesthetist, Certified Registered | 4120-b N. Valdosta Road, Valdosta, GA 31602 | 2016-11-09 |
| 1134670557 | Cataract and Laser Surgery Center of South Georgia, P.C. | Clinic/Center | 4120-b N. Valdosta Rd., Valdosta, GA 31602 | 2016-10-20 |
| Find all providers in zip 31602 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326335993 | South Georgia Medical Practice | Internal Medicine | 2704 N Oak St Bldg A2, Valdosta, GA 31602-5900 | 2011-07-05 |
| 1477782233 | Rose Horne | Internal Medicine | 1616 Norman Dr Ste B, Valdosta, GA 31601-7723 | 2009-07-14 |
| 1265612972 | Jonathan Lance Underwood | Internal Medicine | 3207 Country Club Rd, Valdosta, GA 31605-1029 | 2007-11-09 |
| 1881612067 | Spencer Price | Internal Medicine | 3769 Bear Lake Rd, Valdosta, GA 31601 | 2006-07-17 |
| 1366470650 | Brian C Griner | Internal Medicine | 3301 N Oak Street Ext, Valdosta, GA 31605-1014 | 2006-06-28 |
| 1548297195 | Larry E Smith | Internal Medicine | 5116 Northwind Blvd, Valdosta, GA 31605 | 2006-06-27 |
| 1205873700 | Moneer Ahmad Sohail | Internal Medicine | 3314 Chardon Way, Valdosta, GA 31602-4901 | 2006-06-01 |
| 1588619639 | Dhanraj N Padhiar | Internal Medicine | 207 Northside Dr, Valdosta, GA 31602-1859 | 2006-05-24 |
| 1215990098 | George Sidney Staton | Internal Medicine | 410 Connell Road, Valdosta, GA 31602 | 2006-04-11 |
| 1124003587 | Prem Kumar | Internal Medicine | 3300 Greystone Way, Valdosta, GA 31605-1096 | 2005-12-08 |
| Find all providers in VALDOSTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.