South Georgia Endoscopy Center, Inc

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

148228 Issued in GA

Legal business name

SOUTH GEORGIA ENDOSCOPY CENTER, INC

Practice address

1501 Alice St
Waycross, GA 31501-4530

Phone

(912) 285-0877

Fax

(912) 287-0387

NPI assigned

Aug 18, 2006

Last updated

Jan 2, 2013By 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

Sohail A Choudhri, M.D.NPI 1407960289

Title

Owner

Phone

(912) 285-0877

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Listed as

South Georgia Endoscopy Center IncCCN 11C0001196

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Locations

Practitioners 2

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.

• Sohail A Choudhri, M.D.

  • Gastroenterology Physician
  • Waycross, GA
  • NPI 1407960289
  NPD (past) Authorized official
• Craig M Kubik, D.O.

  • Gastroenterology Physician
  • Waycross, GA
  • NPI 1821102617
  NPD

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357084800000",
    "number": "1841304797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 ALICE ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315014530",
            "telephone_number": "912-285-0877",
            "fax_number": "912-287-0387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 ALICE ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315014530",
            "telephone_number": "912-285-0877",
            "fax_number": "912-287-0387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH GEORGIA ENDOSCOPY CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2013-01-02",
        "status": "A",
        "authorized_official_last_name": "CHOUDHRI",
        "authorized_official_first_name": "SOHAIL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-285-0877",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "148228",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00539459C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Keri Smith, MED, CCC-SLP
• Laura Smith, LMSW
• Sabrina Music Smith, CCC-SLP
• Steven Austin Smith, PHARMD
• Tara D Smith, APRN,FNP-C, PMHNP-BC
• South Georgia Lung Specialists,PC
• South Georgia Physicians Group, LLC
• South Georgia Surgery Center
• South Georgia Surgery Center, LLC (South Georgia Surgery Center)
• Southeast Diagnostics LLC

• Ambulatory Surgical Clinic/Center in Waycross, GA
• Providers in Waycross, GA by specialty
• Ambulatory Surgical Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 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.