NPIMap

Organization Active NPI

Cooperative Healthcare Services Inc

Doing business as Southeast Georgia Physicians Associates Camden Pediatrics

  • Family Nurse Practitioner
  • Saint Marys, GA
National Provider Identifier
1659709152
Registry record updated Oct 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN191658 Issued in GA
Legal business name
COOPERATIVE HEALTHCARE SERVICES INC
Doing business as
Southeast Georgia Physicians Associates Camden Pediatrics
Practice address
2040 Dan Proctor Dr
Suite 140
Saint Marys, GA 31558-3811
Phone
(912) 679-8000
NPI assigned
Oct 17, 2013
Last updated
Oct 17, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
COOPERATIVE HEALTHCARE SERVICES INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 17, 2013

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

Authorized official

Name
Mrs. Judy Marshall
Title
Manager, Physician Practices
Phone
(912) 466-5520

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X RN191658 GA Primary

Addresses

Primary practice location

2040 Dan Proctor Dr
Suite 140
Saint Marys, GA 31558-3811

Mailing address

2040 Dan Proctor Dr
Suite 140
Saint Marys, GA 31558-3811
Phone (912) 679-8000

Other names 1

  • Southeast Georgia Physicians Associates Camden Pediatrics Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D1040187Southeast Georgia Physician Associates2040 Dan Proctor Drive Suite 140, Saint Marys, GA 31558Certificate of waiverMay 2, 2027

National Provider Directory

National Provider Directory
Tax ID family
Cooperative Healthcare Inc2 organizations share this tax ID, including this one
Part of
Cooperative Healthcare Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1381968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381968000000",
    "number": "1659709152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2040 DAN PROCTOR DR",
            "address_2": "SUITE 140",
            "city": "SAINT MARYS",
            "state": "GA",
            "postal_code": "315583811",
            "telephone_number": "912-679-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2040 DAN PROCTOR DR",
            "address_2": "SUITE 140",
            "city": "SAINT MARYS",
            "state": "GA",
            "postal_code": "315583811",
            "telephone_number": "912-679-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOPERATIVE HEALTHCARE SERVICES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COOPERATIVE HEALTHCARE SERVICES INC",
        "enumeration_date": "2013-10-17",
        "last_updated": "2013-10-17",
        "status": "A",
        "authorized_official_last_name": "MARSHALL",
        "authorized_official_first_name": "JUDY",
        "authorized_official_title_or_position": "MANAGER, PHYSICIAN PRACTICES",
        "authorized_official_telephone_number": "912-466-5520",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN191658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeast Georgia Physicians Associates Camden Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Marys, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.