SOUTHERN MEDICAL GROUP (NPI# 1871677880) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871677880 |
| Entity Type | Organization |
| Organization Name | SOUTHERN MEDICAL GROUP |
| Practice Address |
601 S Veterans Blvd Glennville GA 30427-1775 |
| Mailing Address |
Po Box 217 Claxton GA 30417-0217 |
| Practice Telephone | 9126540475 |
| Mailing Telephone | 9126540475 |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2011-09-06 |
| Authorized Official Name | MATT TUCKER (BUSINESS OFFICE MANAGER) |
| Authorized Official Telephone | 9126540475 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 000461 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 300033425A | 05 | |
| GA | RAILROAD MEDICARE | CI8763 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447339015 | Southern Medical Group | Internal Medicine | 601 S. Veterans Blvd, Glennville, GA 30427 | 2006-11-03 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| North Carolina Corporations | Southern Medical Group Inc | 818 West 5th Street, Washington, NC 27889 |
| Street Address |
601 S VETERANS BLVD |
| City | GLENNVILLE |
| State | GA |
| Zip Code | 30427-1775 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265515019 | Paul W Thompson | Family Medicine | 601 S Veterans Blvd, Glennville, GA 30427-1775 | 2006-10-23 |
| 1902434145 | Jessica Joyner Huggins | Nurse Practitioner | 601 S Veterans Blvd, Glennville, GA 30427-1775 | 2020-04-01 |
| 1356764450 | Southern Medical Associates, LLC | Family Medicine | 601 S Veterans Blvd, Glennville, GA 30427-1775 | 2014-01-24 |
| 1871938415 | Kristen Ashley Thomas | Physician Assistant | 601 S Veterans Blvd, Glennville, GA 30427-1775 | 2013-05-09 |
| 1831421908 | Kelly E Daus | Physician Assistant | 601 S Veterans Blvd, Glennville, GA 30427-1775 | 2010-02-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972097608 | Carlton Wendell Durrence IIi | Pharmacist | 15214 Us Highway 301, Glennville, GA 30427 | 2018-06-16 |
| 1790145258 | Lisa Dasher Anderson | Nurse Practitioner | 1000b North Veterans Boulevard, Glennville, GA 30427 | 2016-02-26 |
| 1902203722 | Kimberly Cason | Radiologic Technologist | 3945 Hwy 301, Glennville, GA 30427 | 2014-11-21 |
| 1598901696 | Jana Lamb Bunch | Nurse Practitioner | 1000 B. North Veterans Blvd, Glennville, GA 30427 | 2008-12-20 |
| 1407979420 | Sutton Place | Assisted Living Facility | 306 West Mann Street, Glennville, GA 30427 | 2007-04-06 |
| 1528192846 | Orthopedic Center PC | Orthopaedic Surgery | 601 S. Main St., Glennville, GA 30427 | 2007-03-16 |
| 1447339015 | Southern Medical Group | Internal Medicine | 601 S. Veterans Blvd, Glennville, GA 30427 | 2006-11-03 |
| 1154435550 | Roger W Beville | Family Medicine | 1000 B. North Veterans Boulevard, Glennville, GA 30427 | 2006-08-19 |
| 1265545115 | Sang Wan Oh | General Practice | 257 South Main Street, Reidsville, GA 30427 | 2006-08-16 |
| 1982613568 | Kenneth Lane Durrence | Physical Therapist | 104 W. Rustin St., Glennville, GA 30427 | 2006-08-05 |
| Find all providers in zip 30427 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972762508 | Tattnall Hospital Company, LLC | Family Medicine | 1000b North Veterans Blvd, Glennville, GA 30427-8603 | 2008-06-09 |
| 1265515019 | Paul W Thompson | Family Medicine | 601 S Veterans Blvd, Glennville, GA 30427-1775 | 2006-10-23 |
| 1154435550 | Roger W Beville | Family Medicine | 1000 B. North Veterans Boulevard, Glennville, GA 30427 | 2006-08-19 |
| 1356764450 | Southern Medical Associates, LLC | Family Medicine | 601 S Veterans Blvd, Glennville, GA 30427-1775 | 2014-01-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124629365 | Dima Healthcare, Inc | Family Medicine | 7768 Cumming Hwy Ste 300, Canton, GA 30115-2982 | 2020-11-04 |
| 1871192260 | Ashley Willingham | Family Medicine | 210 Carlisle Way, Savannah, GA 31419-6606 | 2020-10-18 |
| 1831706217 | Veronica Vante | Family Medicine | 200 Business Center Dr Ste 204, Stockbridge, GA 30281-9025 | 2020-09-29 |
| 1912514969 | Oasis Healthcare Service | Family Medicine | 2195 Pace St Ste E, Covington, GA 30014-6657 | 2020-09-24 |
| 1881200772 | My Nurse Now, LLC | Family Medicine | 7070 Hodgson Memorial Dr, Savannah, GA 31406-2529 | 2020-09-16 |
| 1598377319 | Renee Green Lewis | Family Medicine | 9 Bluelake Blvd, Pooler, GA 31322-9617 | 2020-08-21 |
| 1841800836 | Ascend Medical Georgia PC | Family Medicine | One Alliance Center, 3500 Lenox Road Suite 1500, Atlanta, GA 30326 | 2020-08-04 |
| 1407464084 | Railyard Family Medicine LLC | Family Medicine | 416 Grayson Pkwy, Grayson, GA 30017-1220 | 2020-07-20 |
| 1851909535 | Newly Sought After International LLC | Family Medicine | 11815 Northfall Ln Ste 1001, Alpharetta, GA 30009-7973 | 2020-07-17 |
| 1992323398 | Careperks LLC | Family Medicine | 4936 Presidents Way, Tucker, GA 30084-3038 | 2020-07-12 |
| Find all providers with the same taxonomy | ||||
| City | GLENNVILLE |
| Zip Code | 30427 |
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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.