NPIMap

Organization Active NPI

SGMP Southland LLC

  • Psychiatry Physician
  • Valdosta, GA
National Provider Identifier
1447695085
Registry record updated May 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
SGMP SOUTHLAND LLC
Practice address
2209 Pineview Dr
Valdosta, GA 31602-7316
Phone
(229) 236-0831
NPI assigned
May 9, 2013
Last updated
May 13, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2022

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

Authorized official

Name
Stephanie Fletcher
Title
Cfo
Phone
(229) 236-0831

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 59451 GA
Primary Care Clinic/Center 261QP2300X 59451 GA
Psychiatry Physician 2084P0800X Primary

Addresses

Primary practice location

2209 Pineview Dr
Valdosta, GA 31602-7316

Mailing address

PO Box 1276
Thomasville, GA 31799-1276
Phone (229) 236-0831

Other practice location 1

1150 Cornell Ave
Savannah, GA 31406-2702
Phone (229) 236-0831

Other practice location 2

2927 Demere Rd
Saint Simons Is, GA 31522-1620
Phone (229) 236-0831

Other practice location 3

116 W Thigpen Ave
Suite D
Lakeland, GA 31635-1011
Phone (229) 482-8585

Other practice location 4

100 S Madison St
Thomasville, GA 31792-5473
Phone (229) 236-0831

Other practice location 5

201 Woodrow Wilson Dr
Valdosta, GA 31602-2538
Phone (229) 469-5484

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, AL, FL3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20130812000452 GA Part B Supplier - Clinic/Group Practice 1153563770 Receives reassigned benefits from 102 practitioners
Practice locations: Waycross, GA; Valdosta, GA; Savannah, GA; St Simons Is, GA; Augusta, GA
O20200925001644 AL Part B Supplier - Clinic/Group Practice 1153563770 Receives reassigned benefits from 5 practitioners
Practice locations: Dothan, AL
O20231024001078 FL Part B Supplier - Clinic/Group Practice 1153563770 Receives reassigned benefits from 10 practitioners
Practice locations: Wesley Chapel, FL

National Provider Directory

National Provider Directory

Locations

453B Lakes Blvd
Lake Park, GA 31636
Phone (229) 300-5896

116 W Thigpen Ave
Ste D
Lakeland, GA 31635
Phone (229) 482-8585

1150 Cornell Ave
Savannah, GA 31406
Phone (912) 354-3911

Practitioners & affiliated clinicians

Practitioners 117

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.

View all 117

NPI Registry JSON

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

{
    "created_epoch": "1368057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652400000000",
    "number": "1447695085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1276",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317991276",
            "telephone_number": "229-236-0831",
            "fax_number": "229-236-0871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2209 PINEVIEW DR",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316027316",
            "telephone_number": "229-236-0831"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1150 Cornell Ave",
            "address_purpose": "LOCATION",
            "city": "Savannah",
            "state": "GA",
            "postal_code": "314062702",
            "country_code": "US",
            "telephone_number": "229-236-0831",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2927 Demere Rd",
            "address_purpose": "LOCATION",
            "city": "Saint Simons Is",
            "state": "GA",
            "postal_code": "315221620",
            "country_code": "US",
            "telephone_number": "229-236-0831",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "116 W Thigpen Ave",
            "address_2": "Suite D",
            "address_purpose": "LOCATION",
            "city": "Lakeland",
            "state": "GA",
            "postal_code": "316351011",
            "country_code": "US",
            "telephone_number": "229-482-8585",
            "fax_number": "229-482-8586",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 S Madison St",
            "address_purpose": "LOCATION",
            "city": "Thomasville",
            "state": "GA",
            "postal_code": "317925473",
            "country_code": "US",
            "telephone_number": "229-236-0831",
            "fax_number": "229-236-0871",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "201 Woodrow Wilson Dr",
            "address_purpose": "LOCATION",
            "city": "Valdosta",
            "state": "GA",
            "postal_code": "316022538",
            "country_code": "US",
            "telephone_number": "229-469-5484",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SGMP SOUTHLAND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-09",
        "last_updated": "2022-05-13",
        "certification_date": "2022-05-13",
        "status": "A",
        "authorized_official_last_name": "FLETCHER",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "229-236-0831"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "GA",
            "license": "59451",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "59451",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valdosta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2022; 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.