NPIMap

Organization Active NPI

SGPC, PC

Doing business as South Georgia Pediatric Denitstry

  • Pediatric Dentistry
  • Valdosta, GA
National Provider Identifier
1104128263
Registry record updated Feb 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DN014976 Issued in GA
Legal business name
SGPC, PC
Doing business as
South Georgia Pediatric Denitstry
Practice address
3227 N Oak Street Ext
Suite a
Valdosta, GA 31605-7416
Phone
(229) 247-3200
NPI assigned
Nov 23, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2016

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

Authorized official

Name
Mr. Joseph C Powell, DDSNPI 1497019640
Title
Owner/Dentist
Phone
(229) 247-3200

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X DN014976 GA Primary

Addresses

Primary practice location

3227 N Oak Street Ext
Suite a
Valdosta, GA 31605-7416

Mailing address

3227 N Oak Street Ext
Suite a
Valdosta, GA 31605-7416
Phone (229) 247-3200

Other identifiers 3

IdentifierTypeStateIssuer
102640352AMedicaidGA
00917067BMedicaidGA
003162889BMedicaidGA

Other names 1

  • South Georgia Pediatric Denitstry Doing business as

National Provider Directory

National Provider Directory

Locations

3227 N Oak Street Ext
Ste A
Valdosta, GA 31605
Phone (229) 247-3200

Practitioners & affiliated clinicians

Practitioners 2

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": "1290470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454284800000",
    "number": "1104128263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3227 N OAK STREET EXT",
            "address_2": "SUITE A",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316057416",
            "telephone_number": "229-247-3200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3227 N OAK STREET EXT",
            "address_2": "SUITE A",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316057416",
            "telephone_number": "229-247-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SGPC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-23",
        "last_updated": "2016-02-01",
        "status": "A",
        "authorized_official_last_name": "POWELL",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "229-247-3200",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN014976",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102640352A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00917067B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003162889B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Georgia Pediatric Denitstry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Valdosta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2016; 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.