NPIMap

Organization Active NPI

South Georgia Medical Center Inc

Doing business as SGMC Berrien Campus

  • General Acute Care Hospital
  • Nashville, GA
National Provider Identifier
1689440091
Registry record updated Nov 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
SOUTH GEORGIA MEDICAL CENTER INC
Doing business as
SGMC Berrien Campus
SGMC Health Berrien
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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU
General Acute Care Hospital 282N00000X NU Primary

Addresses

Primary practice location

1221 E McPherson Ave
Nashville, GA 31639-2326

Mailing address

PO Box 9
Valdosta, GA 31603-0009

Other names 2

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

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20240409004745 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 1689440091. Details of each certification follow.

Hospital certification: CCN 110234

Legal name
SOUTH GEORGIA MEDICAL CENTER INC
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Sep 9, 2013
Last certification
Aug 27, 2025
Beds
63
Ownership / control type
Other
Most recent change of ownership
Nov 1, 2023 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Nov 9, 2021 in GA
Enrollment address
1221 E McPherson Ave
Nashville, GA 31639-2326
Main/Primary Hospital Location
Hospital subgroups
Acute care

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.

Care Compare: Hospital

Medicare Care Compare
Listed as
SGMC Berrien CampusCCN 110234 · All quality measures
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Other
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

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.

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 IncValdosta, GA, CCN 11T122 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2023
South Georgia Medical Center IncNashville, GA, CCN 11S234 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 6

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.

Affiliated clinicians 86

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 86

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": "1689440091",
    "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": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SGMC Berrien Campus",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SGMC Health Berrien",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nashville, GA

Sources for this page

Verify at the official NPI Registry.