South Georgia Medicine, P.C.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

021582 Issued in GA

Legal business name

SOUTH GEORGIA MEDICINE, P.C.

Practice address

1111 20TH St E
Tifton, GA 31794-3689

Phone

(229) 382-9338

Fax

(229) 382-4282

NPI assigned

Dec 5, 2006

Organization subpart

No

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

Authorized official

Name

Shirley Vickers Carrington

Title

Billing Manager

Phone

(229) 382-9338

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Misty Leigh McGough, FNP

  • Family Nurse Practitioner
  • Moultrie, GA
  • NPI 1942884275

  GA

  Medicare reassignment NPD
• Don Wayne Roberts, MD

  • Gastroenterology Physician
  • Moultrie, GA
  • NPI 1780755918

  GA, Gastroenterology

  Medicare reassignment NPD
• Margarett Ann Walden, NP-C

  • Family Nurse Practitioner
  • Spartanburg, SC
  • NPI 1477099661

  GA

  Medicare reassignment NPD

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624233600000",
    "number": "1528126182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 20TH ST E",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943689",
            "telephone_number": "229-382-9338",
            "fax_number": "229-382-4282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 20TH ST E",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943689",
            "telephone_number": "229-382-9338",
            "fax_number": "229-382-4282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH GEORGIA MEDICINE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A",
        "authorized_official_last_name": "CARRINGTON",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_middle_name": "VICKERS",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "229-382-9338"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "GA",
            "license": "021582",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300029134A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CA5040",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1023084000",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "11D090618",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• South Georgia CSB
• South Georgia Dermatology, PC
• South Georgia Drug Company LLC
• South Georgia Eye Partners
• South Georgia Eye Partners PC
• South Georgia Neurological Associates, P.C.
• South Georgia Pain Management
• South Georgia Physicians for Women
• South Georgia Surgical Clinic PC
• South Georgia Vascular Clinic

• All providers in Tifton, GA
• Gastroenterology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2021; 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.