NPIMap

Organization Active NPI

Southern Pediatric Clinic, LLC

  • Pediatrics Physician
  • Valdosta, GA
National Provider Identifier
1982858767
Registry record updated Feb 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
SOUTHERN PEDIATRIC CLINIC, LLC
Practice address
406 M Northside Drive
Valdosta, GA 31602
Phone
(229) 241-0059
Fax
(229) 241-0059
NPI assigned
Nov 6, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2017

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

Authorized official

Name
Dr. Charlene C Blache, M.D.NPI 1538139712
Title
Owner/Physician
Phone
(229) 241-0059

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

406 M Northside Drive
Valdosta, GA 31602

Mailing address

406 M Northside Drive
Valdosta, GA 31602
Phone (229) 241-0059

National Provider Directory

National Provider Directory

Locations

207 Northside Dr
Valdosta, GA 31602
Phone (229) 242-5050

406 Northside Dr
Ste M
Valdosta, GA 31602
Phone (229) 241-0059

2601 Bemiss Rd
Ste C
Valdosta, GA 31602
Phone (912) 241-1950

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/10369/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 9

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": "1225929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486080000000",
    "number": "1982858767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 M NORTHSIDE DRIVE",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "31602",
            "telephone_number": "229-241-0059",
            "fax_number": "229-241-2088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 M NORTHSIDE DRIVE",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "31602",
            "telephone_number": "229-241-0059",
            "fax_number": "229-241-0059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN PEDIATRIC CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-06",
        "last_updated": "2017-02-03",
        "status": "A",
        "authorized_official_last_name": "BLACHE",
        "authorized_official_first_name": "CHARLENE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "229-241-0059",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valdosta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.