NPIMap

Organization Active NPI

South Georgia Medical Center Inc

Doing business as SGMC Berrien Campus

  • Psychiatric Hospital Unit
  • Nashville, GA
National Provider Identifier
1497521801
Registry record updated Nov 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
SOUTH GEORGIA MEDICAL CENTER INC
Doing business as
SGMC Berrien Campus
SGMC Berrien Cmapus
SGMC Berrien Health
Practice address
1221 E McPherson Ave
Nashville, GA 31639-2326
Phone
(229) 433-8600
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
Psychiatric Hospital Unit 273R00000X Primary

Addresses

Primary practice location

1221 E McPherson Ave
Nashville, GA 31639-2326

Mailing address

PO Box 9
Valdosta, GA 31603-0009

Other names 3

  • SGMC Berrien Campus Doing business as
  • SGMC Berrien Cmapus Doing business as
  • SGMC Berrien Health Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20240410003462 GA Part A Provider - Hospital 1052764677 Practice locations: Nashville, 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 1497521801. Details of each certification follow.

Hospital certification: CCN 11S234

Legal name
SOUTH GEORGIA MEDICAL CENTER INC
Organization structure
CorporationNon-profit
Incorporated
Nov 9, 2021 in GA
Enrollment address
1221 E McPherson Ave
Nashville, GA 31639-2326
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

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.

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

604 E Park Ave
Valdosta, GA 31602
Phone (229) 333-0277

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Ronnie Dean Individual Corporate OfficerCeo Nov 8, 2019
W-2 Managing EmployeeAd; Nov 8, 2019
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 IncLakeland, GA, CCN 115707 Skilled nursing facility 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 9

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": "1701043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762214400000",
    "number": "1497521801",
    "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": "1221 E MCPHERSON AVE",
            "city": "NASHVILLE",
            "state": "GA",
            "postal_code": "316392326",
            "telephone_number": "229-433-8600"
        }
    ],
    "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": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SGMC Berrien Campus",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SGMC Berrien Cmapus",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SGMC Berrien Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nashville, GA

Sources for this page

Verify at the official NPI Registry.