South Georgia Medical Center Inc
Organization Active NPI Psychiatric Hospital Unit · Nashville, GA
NPI 1497521801 · NPPES record last updated Nov 4, 2025
Key facts
- NPI
- 1497521801
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatric Hospital Unit 273R00000X
- Legal business name
- SOUTH GEORGIA MEDICAL CENTER INC
- Practice address
- 1221 E McPherson Ave
Nashville, GA 31639-2326 - Phone
- (229) 433-8600
- NPI assigned
- Nov 27, 2023
- Organization subpart
- Yes
- Parent organization (as reported)
- SOUTH GEORGIA MEDICAL CENTER INC
Authorized official
- Name
- Olaf Faeskorn
- Title
- VP Revenue Cycle
- Phone
- (229) 259-4749
Owners & managing parties with NPI records 6
Owned or controlled facilities with NPI records 5
Other NPIs on the same Medicare enrollment 5
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 7
Related certifications (CCN) 1
Facilities with the same owner 5
Practitioners 61
-
Paul Adedoyin, M.D.
-
Pankaj Agrawal, MBBS
-
Cyrus Kao, M.D.
-
Jose Morel, MD
-
Gretchen Nicole Anderson, D.O.
-
Gregory S Beale, M.D.
-
Savita Bidyasar, MD
-
Mi Hyun Choi, FNP-C
-
Tambrea Toylett Ellison, M.D.
-
Vadley Faugue, MD
-
Venkata Gandi, MD
-
Jaime Catherine Gilbert, DNP, FNP
-
Riaz Qadeer Gill, MD
-
Brian C Griner, M.D.
-
Khwaja Fahad Haq, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in GA
Hospital certification: CCN 11S234
- Legal name
- SOUTH GEORGIA MEDICAL CENTER INC
- Organization structure
- Corporation · Non-profit
- Incorporated
- Nov 9, 2021 in GA
- Enrollment address
- 1221 E McPherson Ave
Nashville, GA 31639-2326 - Hospital subgroups
- Psychiatric unit
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Ronnie Dean |
Corporate Officer |
Nov 8, 2019 | |
| W-2 Managing Employee |
Nov 8, 2019 | ||
| South Georgia Medical Center Inc |
5% Or Greater Direct Ownership Interest | Nov 1, 2023 | 100% |
| John Moore |
Corporate Officer |
Jul 19, 2021 | |
| W-2 Managing Employee |
Jul 19, 2021 | ||
| Julie Hodges |
Corporate Officer |
Jul 6, 2015 | |
| W-2 Managing Employee |
Jul 6, 2015 |
All facility ownership & control disclosures 5
| Facility | Type | Role | Since |
|---|---|---|---|
| South Georgia Medical Center Inc |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Nov 1, 2023 |
| South Georgia Medical Center Inc |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Nov 1, 2023 |
| South Georgia Medical Center Inc |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Nov 1, 2023 |
| South Georgia Medical Center Inc |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Nov 1, 2023 |
| South Georgia Medical Center Inc |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Nov 1, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- South Georgia Medical Center Inc
- Part of
- South Georgia Medical Center Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric Hospital Unit | 273R00000X | Yes |
Addresses
Primary practice location
1221 E McPherson Ave
Nashville, GA 31639-2326
Mailing address
PO Box 9
Valdosta, GA 31603-0009
Other names
- SGMC Berrien Campus
- SGMC Berrien Cmapus
- SGMC Berrien Health
Other providers in Nashville, GA
- Stephen Watson Shiver Sr.
- Betty Ann Smith
- Andrew Wayne Solomon
- South Central Primary Care Center, Inc
- South Georgia Behavior Associates
- South Georgia Medical Center Inc
- South Health District
- Southland-Nashville Emergency Services, LLC
- Southland-Nashville Emergency Services, LLC.
- Southwest Georgia Rehab, Inc
All providers in Nashville, GA · Psychiatric Hospital Unit in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 4, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.