NPIMap

Organization Active NPI

Southland Behavioral Health Services LLC

  • Hospitalist Physician
  • Valdosta, GA
National Provider Identifier
1619505765
Registry record updated Apr 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
Legal business name
SOUTHLAND BEHAVIORAL HEALTH SERVICES LLC
Practice address
2209 Pineview Dr
Valdosta, GA 31602-7316
Phone
(229) 236-0831
Fax
(229) 236-0871
NPI assigned
Apr 1, 2020
Last updated
Apr 1, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2020

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Hospitalist Physician 208M00000X NU 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

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

Other practice location 2

633 Stephenson Ave
Savannah, GA 31405-5970
Phone (229) 236-0831

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL www.southlandmd.com Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20200511002208 GA Part B Supplier - Clinic/Group Practice 8224469085 Receives reassigned benefits from 29 practitioners
Practice locations: Augusta, GA; Savannah, GA; St Simons Is, GA; Valdosta, GA
O20210107000920 AL Part B Supplier - Clinic/Group Practice 8224469085 Receives reassigned benefits from 7 practitioners
Practice locations: Dothan, AL
O20230921003594 FL Part B Supplier - Clinic/Group Practice 8224469085 Receives reassigned benefits from 6 practitioners
Practice locations: Wesley Chapel, FL

National Provider Directory

National Provider Directory

Locations

3100 Perimeter Pkwy
Augusta, GA 30909
Phone (706) 650-3207

Networks

  • HealthSun Health Plans Network

Practitioners & affiliated clinicians

Practitioners 40

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 40

NPI Registry JSON

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

{
    "created_epoch": "1585699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585699200000",
    "number": "1619505765",
    "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",
            "fax_number": "229-236-0871"
        }
    ],
    "practiceLocations": [
        {
            "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",
            "fax_number": "229-236-0871",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "633 Stephenson Ave",
            "address_purpose": "LOCATION",
            "city": "Savannah",
            "state": "GA",
            "postal_code": "314055970",
            "country_code": "US",
            "telephone_number": "229-236-0831",
            "fax_number": "229-236-0871",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHLAND BEHAVIORAL HEALTH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-01",
        "last_updated": "2020-04-01",
        "certification_date": "2020-04-01",
        "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": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.southlandmd.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "No connection",
            "address_1": "2209 Pineview Dr",
            "city": "Valdosta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "316027316",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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 Apr 1, 2020; 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.