NPIMap

Organization Active NPI

SGMC Affiliated Services LLC

  • Multi-Specialty Clinic/Center
  • Valdosta, GA
National Provider Identifier
1114740362
Registry record updated Nov 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
SGMC AFFILIATED SERVICES LLC
Practice address
2501 N Patterson St
Valdosta, GA 31602-1735
Phone
(229) 433-1000
NPI assigned
Nov 6, 2024
Last updated
Nov 4, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2025

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

Authorized official

Name
Olaf Faeskorn
Title
VP Revenue Cycle
Phone
(229) 259-4749

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary
Urgent Care Clinic/Center 261QU0200X

Addresses

Primary practice location

2501 N Patterson St
Valdosta, GA 31602-1735

Mailing address

PO Box 9
Valdosta, GA 31603-0009

Other practice location 1

4280 N Valdosta Rd
Valdosta, GA 31602-6814
Phone (229) 433-8000

Other practice location 2

4256 N Valdosta Rd
Valdosta, GA 31602-6814
Phone (229) 433-8200

Other practice location 3

520 Griffin Ave Ste A
Valdosta, GA 31601-6331
Phone (229) 433-7340

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250128002845 GA Part B Supplier - Clinic/Group Practice 5496284028 Receives reassigned benefits from 66 practitioners
Practice locations: Valdosta, GA

National Provider Directory

National Provider Directory

Locations

2310 N Patterson St
Bldg D
Valdosta, GA 31602
Phone (229) 247-2482

520 Griffin Ave
Ste A
Valdosta, GA 31601
Phone (229) 433-7340

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 230

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.

View all 230

NPI Registry JSON

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

{
    "created_epoch": "1730851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762214400000",
    "number": "1114740362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316030009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 N PATTERSON ST",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021735",
            "telephone_number": "229-433-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4280 N Valdosta Rd",
            "address_purpose": "LOCATION",
            "city": "Valdosta",
            "state": "GA",
            "postal_code": "316026814",
            "country_code": "US",
            "telephone_number": "229-433-8000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4256 N Valdosta Rd",
            "address_purpose": "LOCATION",
            "city": "Valdosta",
            "state": "GA",
            "postal_code": "316026814",
            "country_code": "US",
            "telephone_number": "229-433-8200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "520 Griffin Ave Ste A",
            "address_purpose": "LOCATION",
            "city": "Valdosta",
            "state": "GA",
            "postal_code": "316016331",
            "country_code": "US",
            "telephone_number": "229-433-7340",
            "fax_number": "229-433-7349",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SGMC AFFILIATED SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-06",
        "last_updated": "2025-11-04",
        "certification_date": "2025-11-04",
        "status": "A",
        "authorized_official_last_name": "FAESKORN",
        "authorized_official_first_name": "OLAF",
        "authorized_official_title_or_position": "VP REVENUE CYCLE",
        "authorized_official_telephone_number": "229-259-4749"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Nov 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.