SOUTHLAND MEDICAL GROUP, LLC (NPI# 1790307908) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790307908 |
| Entity Type | Organization |
| Organization Name | SOUTHLAND MEDICAL GROUP, LLC |
| Practice Address |
35 Hospital Rd Blairsville GA 30512-3139 |
| Mailing Address |
Po Box 1276 Thomasville GA 31799-1276 |
| Practice Telephone | 2292360831 |
| Mailing Telephone | 2292360831 |
| Mailing Fax Number | 2292360871 |
| Enumeration Date | 2020-05-11 |
| Last Update Date | 2020-05-11 |
| Authorized Official Name | STEPHANIE FLETCHER (CFO) |
| Authorized Official Telephone | 2292360831 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208M00000X | Hospitalist | Allopathic & Osteopathic Physicians | ||
| Y | 207P00000X | Emergency Medicine | Allopathic & Osteopathic Physicians |
| Street Address |
35 HOSPITAL RD |
| City | BLAIRSVILLE |
| State | GA |
| Zip Code | 30512-3139 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356344048 | Dana Conner | Family Medicine | 35 Hospital Rd, Blairsville, GA 30512-3139 | 2005-05-27 |
| 1255932828 | Laboratory Medicine, PC | Pathology | 35 Hospital Rd, Blairsville, GA 30512-3139 | 2020-11-02 |
| 1245852805 | Cristina Royce | Radiologic Technologist | 35 Hospital Rd, Blairsville, GA 30512-3139 | 2020-05-17 |
| 1174159461 | Blue Ridge Radiology PC | Radiology | 35 Hospital Rd, Blairsville, GA 30512-3139 | 2020-03-18 |
| 1124689856 | Anita Carol English | Nurse Practitioner | 35 Hospital Rd, Blairsville, GA 30512-3139 | 2019-06-24 |
| 1194384958 | Laura Stewart Ors | Physical Therapist | 35 Hospital Rd, Blairsville, GA 30512-3139 | 2019-06-06 |
| 1447819206 | Lissette Goldsberry | Physical Therapy Assistant | 35 Hospital Rd, Blairsville, GA 30512-3139 | 2019-06-06 |
| 1851950646 | Laura Lewis | Physical Therapy Assistant | 35 Hospital Rd, Blairsville, GA 30512-3139 | 2019-06-06 |
| 1235797085 | Laurie Jennifer Guy | Physical Therapy Assistant | 35 Hospital Rd, Blairsville, GA 30512-3139 | 2019-06-05 |
| 1023676939 | Catherine Agacinski | Physical Therapy Assistant | 35 Hospital Rd, Blairsville, GA 30512-3139 | 2019-06-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003456229 | Southeast Eye Group LLC | Optometrist | 17 Hometown Way, Blairsville, GA 30512 | 2020-01-15 |
| 1902395247 | Pamela Jones | Pharmacist | 207 Highway 515, Blairsville, GA 30512 | 2018-05-02 |
| 1780095851 | Joshua R Kennedy | Pediatrics | 77 Weaver Rd Ste B, Blairsville, GA 30512 | 2014-05-12 |
| 1659634889 | Amy Kight | Occupational Therapist | 383 Fox Flds, Blairsville, GA 30512 | 2012-06-22 |
| 1184986846 | Blair House Dental, LLC | Dentist | 10 Deer Crossing Tr., Blairsville, GA 30512 | 2012-06-08 |
| 1215221718 | Connie Duncan | Hearing Instrument Specialist | 281c Young Harris Street, Blairsville, GA 30512 | 2011-06-02 |
| 1407154727 | Georgia Mountains Community Services | Day Training, Developmentally Disabled Services | 10 B Hughes St, Blairsville, GA 30512 | 2011-03-10 |
| 1114228558 | Ingles Markets Inc | Pharmacy | 207b Highway 515, Blairsville, GA 30512 | 2010-11-16 |
| 1720300569 | Steven H. Senart | Chiropractor | 215 Blue Ridge Street, Suite E, Blairsville, GA 30512 | 2010-02-22 |
| 1649407552 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 2257 Hwy 515, Blairsville, GA 30512 | 2009-06-18 |
| Find all providers in zip 30512 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437266285 | Marta Jill Ferguson | Emergency Medicine | Union General Hospital, 214 Hospital Cir, Blairsville, GA 30512-9221 | 2006-08-25 |
| 1538116827 | George David Gowder IIi | Emergency Medicine | 214 Hospital Cir, Blairsville, GA 30512-3102 | 2006-05-30 |
| 1154387579 | Heather Hall | Emergency Medicine | 35 Hospital Way, Blairsville, GA 30512 | 2006-04-25 |
| 1295119667 | Sandra Elizabeth Stepp Patton | Emergency Medicine | 346 Deep South Farm Rd Ste A, Blairsville, GA 30512-2218 | 2015-07-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760081657 | Rtw Health Services LLC | Emergency Medicine | 1951 Lenox Rd Ne, Atlanta, GA 30306-3059 | 2020-10-21 |
| 1790396984 | Chisholm Trail Urgent Care Pllc | Emergency Medicine | 11 Tsys Way, Columbus, GA 31901 | 2020-08-12 |
| 1275141467 | Viral Solutions LLC | Emergency Medicine | 1752 Moonstone Ct, Decatur, GA 30033-1411 | 2020-07-14 |
| 1376102830 | John Edward Cooke | Emergency Medicine | 2411 Tuxedo Ln Nw, Marietta, GA 30064-1898 | 2019-06-10 |
| 1538646526 | Edwige Goby Konwo-tayo | Emergency Medicine | 1183 S Hairston Rd Ste A, Stone Mountain, GA 30088-2796 | 2018-07-23 |
| 1548763899 | South Georgia Er Services, LLC | Emergency Medicine | 313 Carrick Way, Macon, GA 31210-4952 | 2018-03-13 |
| 1922517945 | Infinity Wellness Solutions LLC | Emergency Medicine | 3240 Pointe Parkway, Suite 100, Norcross, GA 30092 | 2017-09-21 |
| 1528594314 | Kendra Chantelle Krieg | Emergency Medicine | 185 Anniversary Ln, Acworth, GA 30102 | 2017-05-11 |
| 1114450806 | Peyton Jones Syed | Emergency Medicine | 13765 Brittle Rd, Alpharetta, GA 30004-3592 | 2017-04-10 |
| 1437690658 | Miles Anthony Medina | Emergency Medicine | 1133 Eagles Landing Pkwy # Er, Stockbridge, GA 30281-5085 | 2017-03-20 |
| Find all providers with the same taxonomy | ||||
| City | BLAIRSVILLE |
| Zip Code | 30512 |
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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.