NPIMap

Organization Active NPI

South Georgia Physicians Group, LLC

  • Internal Medicine Physician
  • Alma, GA
National Provider Identifier
1336560952
Registry record updated Feb 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
SOUTH GEORGIA PHYSICIANS GROUP, LLC
Practice address
204 E 15TH St
Alma, GA 31510
Phone
(912) 632-0314
Fax
(912) 632-2554
NPI assigned
Dec 27, 2013
Last updated
Feb 12, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2026

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 6

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X Primary
Cardiovascular Disease Physician 207RC0000X
Pediatrics Physician 208000000X
Surgery Physician 208600000X

Addresses

Primary practice location

204 E 15TH St
Alma, GA 31510

Mailing address

204 E 15TH St
Alma, GA 31510-2908
Phone (912) 632-0314

Other practice location 1

821 S Main St Ste A
Baxley, GA 31513-0163
Phone (912) 705-5483

Other practice location 2

221 E Carter Ave
Blackshear, GA 31516-1545
Phone (912) 449-6631

Other practice location 3

2650 Carswell Ave
Waycross, GA 31503-4081
Phone (912) 283-1234

Other practice location 4

203 S Wayne St
Alma, GA 31510-2919
Phone (912) 632-8288

Other practice location 5

207 S Wayne St
Alma, GA 31510-2919
Phone (912) 632-7308

Other practice location 6

1600 Riverside Ave
Waycross, GA 31501-7028
Phone (912) 283-1182

Other practice location 7

301 S Baker St
Alma, GA 31510-3019
Phone (912) 632-7293

Other practice location 8

1406 Habersham Dr
Waycross, GA 31501-5306
Phone (912) 287-1130

Other practice location 9

407 W Oneida St
Waycross, GA 31501-5320
Phone (912) 338-0065

Other practice location 10

113 E 15th St
Alma, GA 31510-2905
Phone (912) 632-3818

Other practice location 11

333 W Carter Ave
Blackshear, GA 31516-1412
Phone (912) 632-8961

Other identifiers 1

IdentifierTypeStateIssuer
003144050AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110831000412 GA Part B Supplier - Clinic/Group Practice 8224208251 Receives reassigned benefits from 10 practitioners
2 other NPIs on this enrollment
Practice locations: Waycross, GA; Blackshear, GA; Alma, GA; Baxley, GA

Other NPIs on the same Medicare enrollment 1

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D1060302South Georgia Physicians Group203 South Wayne Street, Alma, GA 31510Provider-performed microscopyJun 29, 2027
11D2262635South Georgia Physicians Group LLC407 W Oneida Street, Waycross, GA 31501Certificate of waiverJun 15, 2028

National Provider Directory

National Provider Directory

Locations

301 S Baker St
Alma, GA 31510
Phone (912) 632-7293

407 W Oneida St
Waycross, GA 31501
Phone (912) 338-0065

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1388102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770854400000",
    "number": "1336560952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 E 15TH ST",
            "city": "ALMA",
            "state": "GA",
            "postal_code": "315102908",
            "telephone_number": "912-632-0314",
            "fax_number": "912-632-2554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 E 15TH ST",
            "city": "ALMA",
            "state": "GA",
            "postal_code": "31510",
            "telephone_number": "912-632-0314",
            "fax_number": "912-632-2554"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "821 S Main St Ste A",
            "address_purpose": "LOCATION",
            "city": "Baxley",
            "state": "GA",
            "postal_code": "315130163",
            "country_code": "US",
            "telephone_number": "912-705-5483",
            "fax_number": "912-705-5484",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "221 E Carter Ave",
            "address_purpose": "LOCATION",
            "city": "Blackshear",
            "state": "GA",
            "postal_code": "315161545",
            "country_code": "US",
            "telephone_number": "912-449-6631",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2650 Carswell Ave",
            "address_purpose": "LOCATION",
            "city": "Waycross",
            "state": "GA",
            "postal_code": "315034081",
            "country_code": "US",
            "telephone_number": "912-283-1234",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "203 S Wayne St",
            "address_purpose": "LOCATION",
            "city": "Alma",
            "state": "GA",
            "postal_code": "315102919",
            "country_code": "US",
            "telephone_number": "912-632-8288",
            "fax_number": "912-632-3758",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "207 S Wayne St",
            "address_purpose": "LOCATION",
            "city": "Alma",
            "state": "GA",
            "postal_code": "315102919",
            "country_code": "US",
            "telephone_number": "912-632-7308",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1600 Riverside Ave",
            "address_purpose": "LOCATION",
            "city": "Waycross",
            "state": "GA",
            "postal_code": "315017028",
            "country_code": "US",
            "telephone_number": "912-283-1182",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "301 S Baker St",
            "address_purpose": "LOCATION",
            "city": "Alma",
            "state": "GA",
            "postal_code": "315103019",
            "country_code": "US",
            "telephone_number": "912-632-7293",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1406 Habersham Dr",
            "address_purpose": "LOCATION",
            "city": "Waycross",
            "state": "GA",
            "postal_code": "315015306",
            "country_code": "US",
            "telephone_number": "912-287-1130",
            "fax_number": "912-827-9114",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "407 W Oneida St",
            "address_purpose": "LOCATION",
            "city": "Waycross",
            "state": "GA",
            "postal_code": "315015320",
            "country_code": "US",
            "telephone_number": "912-338-0065",
            "fax_number": "912-338-0920",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "113 E 15th St",
            "address_purpose": "LOCATION",
            "city": "Alma",
            "state": "GA",
            "postal_code": "315102905",
            "country_code": "US",
            "telephone_number": "912-632-3818",
            "fax_number": "912-632-2921",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "333 W Carter Ave",
            "address_purpose": "LOCATION",
            "city": "Blackshear",
            "state": "GA",
            "postal_code": "315161412",
            "country_code": "US",
            "telephone_number": "912-632-8961",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTH GEORGIA PHYSICIANS GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-27",
        "last_updated": "2026-02-12",
        "certification_date": "2026-02-12",
        "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": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003144050A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Alma, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.