South Ga Spine Care Institute

Primary specialty

Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X

License

051451 Issued in GA

Legal business name

SOUTH GA SPINE CARE INSTITUTE

Practice address

8 Live Oak CT
Moultrie, GA 31768-6783

Phone

(229) 890-6612

Fax

(229) 890-6621

NPI assigned

Feb 7, 2007

Last updated

Dec 16, 2015By 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

Andrew Gregory Cordista, MDNPI 1295745081

Title

Doctor

Phone

(229) 890-6612

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• Andrew G Cordista, MD

  • Orthopaedic Surgery of the Spine Physician
  • Moultrie, GA
  • NPI 1295745081
  Authorized official Same address or phone

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450224000000",
    "number": "1437299740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 LIVE OAK CT",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686783",
            "telephone_number": "229-890-6612",
            "fax_number": "229-890-6621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 LIVE OAK CT",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686783",
            "telephone_number": "229-890-6612",
            "fax_number": "229-890-6621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH GA SPINE CARE INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2015-12-16",
        "status": "A",
        "authorized_official_last_name": "CORDISTA",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "GREGORY",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "229-890-6612",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207XS0117X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "GA",
            "license": "051451",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000921522B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wayland Smith, RN
• Whitney E. Smith, CCC-SLP
• Dresden Melton Soderstrom, MD
• Rumonda Marketta Solomon
• South Ga Gastroenterology & Nutrition Support, Inc.
• South Georgia Clinic of Chiropractic Medicine (Sircy Chiropractic Clinic)
• South Georgia Pharmacy Services Inc (Convenient RX LTC #2)
• Southeastern Urogynecology & Pelvic Surgery LLC (Sterling Group Urogynecology & Pelvic Surgery)
• Southern Orthodontics
• Southern Pelvic Therapy LLC

• Orthopaedic Surgery of the Spine Physician in Moultrie, GA
• Providers in Moultrie, GA by specialty
• Orthopaedic Surgery of the Spine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2015; 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.