South Georgia Physicians Group, LLC

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

Legal business name

SOUTH GEORGIA PHYSICIANS GROUP, LLC

Practice address

1406 Habersham Dr
Waycross, GA 31501-5306

Phone

(912) 287-1130

Fax

(912) 287-9114

NPI assigned

Apr 25, 2019

Last updated

May 16, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Cheryl Crawford Dubose

Title

Cfo

Phone

(912) 632-8961

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• South Georgia Physicians Group, LLC

  • Internal Medicine Physician
  • Alma, GA
  • NPI 1336560952

  O20110831000412

  Same enrollment

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Bacon County Health Services, Inc.

  • Critical Access Hospital
  • Alma, GA
  • NPI 1629185285

  Member Of

  NPD member

Practitioners 1

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.

• Ian Furtado, M.D.

  • Family Medicine Physician
  • Alma, GA
  • NPI 1912358755
  NPD

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

{
    "created_epoch": "1556150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715817600000",
    "number": "1316501372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 E 15TH STREET",
            "city": "ALMA",
            "state": "GA",
            "postal_code": "315102908",
            "telephone_number": "912-632-2952",
            "fax_number": "912-632-8682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1406 HABERSHAM DR",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315015306",
            "telephone_number": "912-287-1130",
            "fax_number": "912-287-9114"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "821 S. MAIN STREET",
            "address_purpose": "LOCATION",
            "city": "BAXLEY",
            "state": "GA",
            "postal_code": "315135306",
            "country_code": "US",
            "telephone_number": "912-705-5483",
            "fax_number": "912-705-5484",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTH GEORGIA PHYSICIANS GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-25",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-16",
        "status": "A",
        "authorized_official_last_name": "DUBOSE",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "CRAWFORD",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "912-632-8961"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1336560952",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sabrina Music Smith, CCC-SLP
• Steven Austin Smith, PHARMD
• Tara D Smith, APRN,FNP-C, PMHNP-BC
• South Georgia Endoscopy Center, Inc
• South Georgia Lung Specialists,PC
• South Georgia Surgery Center
• South Georgia Surgery Center, LLC (South Georgia Surgery Center)
• Southeast Diagnostics LLC
• Southeast Georgia Anesthesia LLC
• Southeast Georgia Gastroenterology PC

• Obstetrics & Gynecology Physician in Waycross, GA
• Providers in Waycross, GA by specialty
• Obstetrics & Gynecology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2024; 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.