NPIMap

Organization Active NPI

South Georgia Vascular Clinic

Doing business as TIft Regional Medical Center d/b/a South Georgia Vascular Clinic

  • Vascular Surgery Physician
  • Tifton, GA
National Provider Identifier
1144454059
Registry record updated May 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
031466 Issued in GA
Legal business name
SOUTH GEORGIA VASCULAR CLINIC
Doing business as
TIft Regional Medical Center d/b/a South Georgia Vascular Clinic
Practice address
901 18TH St E
Tifton, GA 31794-3648
Phone
(229) 382-9733
Fax
(229) 387-6161
NPI assigned
May 6, 2009
Last updated
May 6, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2009

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

Authorized official

Name
Mr. Dennis Crum
Title
VP/Cfo
Phone
(229) 353-6146

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X 031466 GA Primary

Addresses

Primary practice location

901 18TH St E
Tifton, GA 31794-3648

Mailing address

901 18TH St E
Tifton, GA 31794-3648
Phone (229) 382-9733

Other identifiers 3

IdentifierTypeStateIssuer
1003883612OtherGANPI/WILLIAM KAISER, MD
205810921CMedicaidGA
1154356889OtherGANPI/BRAD HOLT PA

Other names 1

  • TIft Regional Medical Center d/b/a South Georgia Vascular Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Tift Regional Health System Inc19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1241568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241568000000",
    "number": "1144454059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 18TH ST E",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943648",
            "telephone_number": "229-382-9733",
            "fax_number": "229-387-6161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 18TH ST E",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943648",
            "telephone_number": "229-382-9733",
            "fax_number": "229-387-6161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH GEORGIA VASCULAR CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-06",
        "last_updated": "2009-05-06",
        "status": "A",
        "authorized_official_last_name": "CRUM",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_title_or_position": "VP/CFO",
        "authorized_official_telephone_number": "229-353-6146",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "GA",
            "license": "031466",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI/WILLIAM KAISER, MD",
            "identifier": "1003883612",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205810921C",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI/BRAD HOLT PA",
            "identifier": "1154356889",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TIft Regional Medical Center d/b/a South Georgia Vascular Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tifton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2009; 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.