NPIMap

Organization Active NPI

South Georgia Medical Center Inc

Doing business as SGMC Health Villa

  • Nursing Facility/Intermediate Care Facility
  • Lakeland, GA
National Provider Identifier
1396511713
Registry record updated Nov 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
Legal business name
SOUTH GEORGIA MEDICAL CENTER INC
Doing business as
SGMC Health Villa
Practice address
138 W Thigpen Ave
Lakeland, GA 31635-1011
Phone
(229) 433-8425
NPI assigned
Nov 27, 2023
Last updated
Nov 4, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTH GEORGIA MEDICAL CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 4, 2025

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

Authorized official

Name
Olaf Faeskorn
Title
VP Revenue Cycle
Phone
(229) 259-4749

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X NU Primary

Addresses

Primary practice location

138 W Thigpen Ave
Lakeland, GA 31635-1011

Mailing address

PO Box 9
Valdosta, GA 31603-0009

Other names 1

  • SGMC Health Villa Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20240328003959 GA Part A Provider - Skilled Nursing Facility 1052764677 Practice locations: Lakeland, GA
O20240514000755 GA Part B Supplier - Clinic/Group Practice 1052764677 Receives reassigned benefits from 110 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Nashville, GA; Valdosta, GA; Lakeland, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396511713. Details of each certification follow.

Skilled nursing facility certification: CCN 115707

Legal name
SOUTH GEORGIA MEDICAL CENTER INC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Nov 1, 2005
Last certification
Jun 4, 2025
Beds
62
Ownership / control type
Hospital District
Organization structure
Not SelectedProprietary
Enrollment address
138 W Thigpen Ave
Lakeland, GA 31635-1011
Nursing home name
SGMC HEALTH VILLA

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 5

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
SGMC Health VillaCCN 115707 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Government - Hospital district
Certified
Nov 1, 2005
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6258.4 residents per day on average

Processed by Care Compare on Aug 1, 2026.

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
11D0915865SGMC Health Villa138 West Thigpen Avenue, Lakeland, GA 31635Certificate of waiverJun 9, 2028

National Provider Directory

National Provider Directory
Tax ID family
South Georgia Medical Center Inc8 organizations share this tax ID, including this one
Part of
South Georgia Medical Center Inc

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

138 W Thigpen Ave
Lakeland, GA 31635
Phone (229) 433-8425

Ownership & related parties

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.

NameRoleSinceShare
South Georgia Medical Center Inc Organization, Valdosta, GA Created for acquisition, Corporation, Non-profit 5% Or Greater Direct Ownership Interest Nov 1, 2023 100%
John Moore Individual Corporate OfficerCfo Jul 19, 2021
W-2 Managing EmployeeCfo Jul 19, 2021
Julie Hodges Individual Corporate OfficerController Jul 6, 2015
W-2 Managing EmployeeController Jul 6, 2015

Owners & managing parties with NPI records 6

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

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
South Georgia Medical Center IncLakeland, GA, CCN 111326 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2023
South Georgia Medical Center IncLakeland, GA, CCN 11Z326 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2023
South Georgia Medical Center IncNashville, GA, CCN 110234 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2023
South Georgia Medical Center IncValdosta, GA, CCN 11T122 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2023
South Georgia Medical Center IncNashville, GA, CCN 11S234 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2023

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 3

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.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1701043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762214400000",
    "number": "1396511713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316030009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 W THIGPEN AVE",
            "city": "LAKELAND",
            "state": "GA",
            "postal_code": "316351011",
            "telephone_number": "229-433-8425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH GEORGIA MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTH GEORGIA MEDICAL CENTER INC",
        "enumeration_date": "2023-11-27",
        "last_updated": "2025-11-04",
        "certification_date": "2025-11-04",
        "status": "A",
        "authorized_official_last_name": "FAESKORN",
        "authorized_official_first_name": "OLAF",
        "authorized_official_title_or_position": "VP REVENUE CYCLE",
        "authorized_official_telephone_number": "229-259-4749"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SGMC Health Villa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakeland, GA

Sources for this page

Verify at the official NPI Registry.