Southern Family Healthcare, P.a.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

SOUTHERN FAMILY HEALTHCARE, P.A.

Practice address

877 3Rd St Ste 4
Chipley, FL 32428-1855

Phone

(850) 638-4383

Fax

(850) 415-6783

NPI assigned

May 4, 2007

Organization subpart

No

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

Authorized official

Name

William Mark Garney, ARNPCNPI 1043230535

Title

President

Phone

(850) 638-5512

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL2 enrollments

Enrollment records 2

Rural health clinic certification: CCN 108947

Legal name

SOUTHERN FAMILY HEALTHCARE, P.A.

Doing business as

N/A

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Jan 9, 2003

Last certification

Feb 5, 2020

Ownership / control type

1B

Organization structure

CorporationProprietary

Incorporated

May 24, 2002 in FL

Enrollment address

877 3Rd Street
Suite 4
Chipley, FL 32428-1855

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• William Mark Garney, ARNP-C

  • Family Nurse Practitioner
  • Chipley, FL
  • NPI 1043230535

  5% Or Greater Direct Ownership Interest, Corporate Director

  CMS ownership
• Annette Griffin Porter, M.D.

  • Family Medicine Physician
  • Chipley, FL
  • NPI 1184647810

  5% Or Greater Direct Ownership Interest, Corporate Director

  CMS ownership

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• William Mark Garney, ARNP-C

  • Family Nurse Practitioner
  • Chipley, FL
  • NPI 1043230535
  Medicare reassignment Care Compare group NPD Authorized official
• Annette Griffin Porter, M.D.

  • Family Medicine Physician
  • Chipley, FL
  • NPI 1184647810

  Single Specialty

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508284800000",
    "number": "1154533677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "877 3RD ST STE 4",
            "city": "CHIPLEY",
            "state": "FL",
            "postal_code": "324281855",
            "telephone_number": "850-638-4383",
            "fax_number": "850-415-6783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "877 3RD ST STE 4",
            "city": "CHIPLEY",
            "state": "FL",
            "postal_code": "324281855",
            "telephone_number": "850-638-4383",
            "fax_number": "850-415-6783"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1376 Brickyard Rd",
            "address_2": "Suite 5",
            "address_purpose": "LOCATION",
            "city": "Chipley",
            "state": "FL",
            "postal_code": "324286303",
            "country_code": "US",
            "telephone_number": "850-638-4383",
            "fax_number": "850-638-4195",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHERN FAMILY HEALTHCARE, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2017-10-18",
        "status": "A",
        "authorized_official_last_name": "GARNEY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-638-5512",
        "authorized_official_credential": "ARNPC"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "FL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "660167700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thomas J Simmons III
• Murphy Llie Megan Sims
• Greg Keith Sloan, M.D.
• Gary Dwayne Smelcer
• Jaleesa Smith
• Southland Hospitlalist at Chipley, PL.
• Jennifer Andreu Stafford, M.A. CCC-SLP
• Steverson Pharmacy Services Inc
• Steverson Pharmacy Services Inc
• William L Steverson, RPH

• Clinic/Center in Chipley, FL
• Providers in Chipley, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.