South Georgia Allergy Clinic PC

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

License

GA023506 Issued in GA

Legal business name

SOUTH GEORGIA ALLERGY CLINIC PC

Practice address

2601 Parkwood Dr
Suite B
Brunswick, GA 31520-4758

Phone

(912) 262-9288

Fax

(912) 262-9994

NPI assigned

Jan 18, 2008

Organization subpart

No

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

Authorized official

Name

Kelly M Dirting, CPC

Title

Billing MGR

Phone

(912) 262-9289

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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

• Carolyn Fowler, PA

  • Medical Physician Assistant
  • Albany, GA
  • NPI 1811068612
  NPD (past)
• Elizabeth Anne Yesbick, NP

  • Family Nurse Practitioner
  • Albany, GA
  • NPI 1194726331
  NPD (past)

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

{
    "created_epoch": "1200614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638144000000",
    "number": "1285810366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1813",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315211813",
            "telephone_number": "912-262-9288",
            "fax_number": "912-262-9994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 PARKWOOD DR",
            "address_2": "SUITE B",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315204758",
            "telephone_number": "912-262-9288",
            "fax_number": "912-262-9994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH GEORGIA ALLERGY CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-18",
        "last_updated": "2021-11-29",
        "certification_date": "2021-11-29",
        "status": "A",
        "authorized_official_last_name": "DIRTING",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BILLING MGR",
        "authorized_official_telephone_number": "912-262-9289",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Allergy & Immunology",
            "state": "GA",
            "license": "GA023506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marianne Davignon Somma, DNP
• South Georgia Psychological Services PC
• South Port Dentistry
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• Southeast Georgia Health System, Inc.
• Southeast Georgia Health System, Inc.

• Allergy & Immunology Physician in Brunswick, GA
• Providers in Brunswick, GA by specialty
• Allergy & Immunology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2021; 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.