NPIMap

Organization Active NPI

SGBS Holdings LLC

Doing business as Southern Pharmacy

  • Community/Retail Pharmacy
  • Statesboro, GA
National Provider Identifier
1083987457
Registry record updated Mar 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHRE009817 Issued in GA
Legal business name
SGBS HOLDINGS LLC
Doing business as
Southern Pharmacy
Practice address
606 Brannen St Ste B
Statesboro, GA 30458-5184
Phone
(912) 225-9279
NPI assigned
Feb 16, 2012
Last updated
Mar 27, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Stacey GirardeauNPI 1568784494
Title
Co-Owner
Phone
(912) 839-5456

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X PHRE009817 GA Primary

Addresses

Primary practice location

606 Brannen St Ste B
Statesboro, GA 30458-5184

Mailing address

606 Brannen St Ste B
Statesboro, GA 30458-5184
Phone (912) 225-9279

Other identifiers 1

IdentifierTypeStateIssuer
1162116OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • Southern Pharmacy Doing business as

National Provider Directory

National Provider Directory

Locations

606 Brannen St
Ste B
Statesboro, GA 30458
Phone (912) 225-9279

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1329350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332806400000",
    "number": "1083987457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "606 BRANNEN ST STE B",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304585184",
            "telephone_number": "912-225-9279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 BRANNEN ST STE B",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304585184",
            "telephone_number": "912-225-9279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SGBS HOLDINGS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-16",
        "last_updated": "2012-03-27",
        "status": "A",
        "authorized_official_last_name": "GIRARDEAU",
        "authorized_official_first_name": "STACEY",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "912-839-5456"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE009817",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1162116",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Statesboro, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.