NPIMap

Organization Active NPI

Southern Healthcare Collaboration, Inc

  • Primary Care Nurse Practitioner
  • Baxley, GA
National Provider Identifier
1750087490
Registry record updated Mar 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
SOUTHERN HEALTHCARE COLLABORATION, INC
Doing business as
Southern Healthcare Collaboration, INC
Practice address
224 Peachtree St
Baxley, GA 31513-8079
Phone
(912) 705-5483
Fax
(912) 705-5484
NPI assigned
Feb 3, 2023
Last updated
Mar 24, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2026

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

Authorized official

Name
Knicole Ann LeeNPI 1972791069
Title
Owner
Phone
(912) 278-0410

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU
Nurse Practitioner 363L00000X NU
Primary Care Nurse Practitioner 363LP2300X NU Primary
Family Medicine Physician 207Q00000X NU
Case Manager/Care Coordinator 171M00000X NU

Addresses

Primary practice location

224 Peachtree St
Baxley, GA 31513-8079

Mailing address

224 Peachtree St
Baxley, GA 31513-8079
Phone (912) 705-5483

Other names 1

  • Southern Healthcare Collaboration, INC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231003002550 GA Part B Supplier - Clinic/Group Practice 8820442247 Receives reassigned benefits from 7 practitioners
Practice locations: Baxley, GA; Surrency, GA

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
11D2273256Southern Healthcare Collaboration, Inc224 Peachtree Street, Baxley, GA 31513Certificate of waiverDec 8, 2026

National Provider Directory

National Provider Directory

Locations

40 Wildes St
Surrency, GA 31563
Phone (912) 705-5483

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1675382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1774310400000",
    "number": "1750087490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 PEACHTREE ST",
            "city": "BAXLEY",
            "state": "GA",
            "postal_code": "315138079",
            "telephone_number": "912-705-5483",
            "fax_number": "912-705-5484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 PEACHTREE ST",
            "city": "BAXLEY",
            "state": "GA",
            "postal_code": "315138079",
            "telephone_number": "912-705-5483",
            "fax_number": "912-705-5484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN HEALTHCARE COLLABORATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-03",
        "last_updated": "2026-03-24",
        "certification_date": "2026-03-24",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "KNICOLE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-278-0410"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Healthcare Collaboration, INC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southern Healthcare Collaboration, INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baxley, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.