NPIMap

Organization Active NPI

South Georgia Spine and Joint Center, LLC

Doing business as South Georgia Spine and Joint Center

  • Family Medicine Physician
  • Thomasville, GA
National Provider Identifier
1770815250
Registry record updated Sep 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SOUTH GEORGIA SPINE AND JOINT CENTER, LLC
Doing business as
South Georgia Spine and Joint Center
Practice address
202 S Madison St
Thomasville, GA 31792-5479
Phone
(229) 226-1035
Fax
(229) 226-3378
NPI assigned
Feb 8, 2010
Last updated
Sep 18, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2013

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

Authorized official

Name
Dr. Michael R Waldrop, D.C.NPI 1952406100
Title
Owner
Phone
(229) 226-1035

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Chiropractor 111N00000X
Family Medicine Physician 207Q00000X Primary
Physical Therapist 225100000X

Addresses

Primary practice location

202 S Madison St
Thomasville, GA 31792-5479

Mailing address

202 S Madison St
Thomasville, GA 31792-5479
Phone (229) 226-1035

Other names 1

  • South Georgia Spine and Joint Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100428000175 GA Part B Supplier - Clinic/Group Practice 5294862090 Receives reassigned benefits from 14 practitioners
Practice locations: Cairo, TN; Thomasville, GA; Bainbridge, GA
O20100930060303 GA DME Supplier - Physician - General Practice 5294862090 Practice locations: Thomasville, 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
11D2033042South Georgia Spine and Joint Center202 South Madison Street, Thomasville, GA 31792Certificate of waiverNov 21, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1265587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379462400000",
    "number": "1770815250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 S MADISON ST",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317925479",
            "telephone_number": "229-226-1035",
            "fax_number": "229-226-3378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 S MADISON ST",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317925479",
            "telephone_number": "229-226-1035",
            "fax_number": "229-226-3378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH GEORGIA SPINE AND JOINT CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-08",
        "last_updated": "2013-09-18",
        "status": "A",
        "authorized_official_last_name": "WALDROP",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "229-226-1035",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Georgia Spine and Joint Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Thomasville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2013; 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.