South Georgia Medical Associates, PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

SOUTH GEORGIA MEDICAL ASSOCIATES, PC

Practice address

410 Connell Rd
Valdosta, GA 31602-1407

Phone

(229) 244-4720

NPI assigned

Jun 19, 2006

Last updated

Mar 14, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kathi Bruch

Title

Administrator

Phone

(229) 244-4720

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

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

CLIA laboratory certificates

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.

• Gregory S Beale, M.D.

  • Pulmonary Disease Physician
  • Valdosta, GA
  • NPI 1497782817
  Medicare reassignment Care Compare group NPD
• William Douglas Luke Jr., MD

  • Cardiovascular Disease Physician
  • Valdosta, GA
  • NPI 1326250036
  Medicare reassignment Care Compare group NPD
• Benjamin L McLeod, NP

  • Family Nurse Practitioner
  • Moultrie, GA
  • NPI 1417405176
  Medicare reassignment Care Compare group NPD
• Milledge C Newton Jr., MD

  • Pulmonary Disease Physician
  • Valdosta, GA
  • NPI 1255369435
  Medicare reassignment Care Compare group NPD
• George Sidney Staton, M.D.

  • Cardiovascular Disease Physician
  • Valdosta, GA
  • NPI 1215990098

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Drimalyn Burgman, NP

  • Nurse Practitioner
  • Valdosta, GA
  • NPI 1316421258
  Medicare reassignment NPD
• Joseph Bret Evans

  • Nurse Practitioner
  • Valdosta, GA
  • NPI 1700353547
  Medicare reassignment NPD
• Lynn S Lee, M.D.

  • Internal Medicine Physician
  • Valdosta, GA
  • NPI 1548298839
  Medicare reassignment NPD

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394755200000",
    "number": "1760427959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 CONNELL RD",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021407",
            "telephone_number": "229-244-4720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 CONNELL RD",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021407",
            "telephone_number": "229-244-4720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH GEORGIA MEDICAL ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-19",
        "last_updated": "2014-03-14",
        "status": "A",
        "authorized_official_last_name": "BRUCH",
        "authorized_official_first_name": "KATHI",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "229-244-4720"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300022100A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• South Georgia Family Medicine
• South Georgia Health Alliance Dba Hospice of South Georgia (Hospice of South Georgia)
• South Georgia Health Group LLC (South Georgia Health Group DME)
• South Georgia Health Group LLC
• South Georgia Health Group, LLC
• South Georgia Medical Center
• South Georgia Medical Center
• South Georgia Medical Center
• South Georgia Medical Center
• South Georgia Medical Center Inc (SGMC Health)

• Internal Medicine Physician in Valdosta, GA
• Providers in Valdosta, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2014; 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.