Southern Pharmacy Group LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

SOUTHERN PHARMACY GROUP LLC

Practice address

110 Allison St.
Jesup, GA 31545

Phone

(912) 559-2961

Fax

(912) 559-2597

NPI assigned

Nov 4, 2020

Organization subpart

No

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

Authorized official

Name

Travis Ray Harrison, PHARMD

Title

Owner

Phone

(912) 294-1684

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

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

• Jeffrey Padgett

  • Pharmacist
  • Jesup, GA
  • NPI 1013573179
  NPD

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

{
    "created_epoch": "1604448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604448000000",
    "number": "1154922441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 LAMBERT BENNETT RD",
            "city": "JESUP",
            "state": "GA",
            "postal_code": "31546",
            "telephone_number": "912-294-1684",
            "fax_number": "912-559-2597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 ALLISON ST.",
            "city": "JESUP",
            "state": "GA",
            "postal_code": "31545",
            "telephone_number": "912-559-2961",
            "fax_number": "912-559-2597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN PHARMACY GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-04",
        "last_updated": "2020-11-04",
        "certification_date": "2020-11-04",
        "status": "A",
        "authorized_official_last_name": "HARRISON",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-294-1684",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southeast Lung & Critical Care Specialists,P.C.
• Southeast Lung and Critical Care Specialist
• Southeastern Pathology Associates at Wayne Memorial Inc
• Southern Family Medicine, LLC
• Southern Medical of Jesup LLC
• Southwest Surgical Associates, P.C.
• Southwest Surgical Associates, P.C.
• Southwest Surgical Associates, PC
• Robson S Spinola, D.P.M.
• Jodi Cheree Spires, LPC

• Community/Retail Pharmacy in Jesup, GA
• Providers in Jesup, GA by specialty
• Community/Retail Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2020; 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.