Organization
SOUTH GEORGIA MEDICAL CENTER INC
Active
Other names
Medical Center Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE W HODGES (CONTROLLER)
(229) 259-4140
Entity
Organization
Contact information
Practice address
2501 N PATTERSON ST, VALDOSTA, GA 31602-1735
(229) 249-4144
(229) 249-4145
Mailing address
PO BOX 1805, VALDOSTA, GA 31603-1805
(229) 433-7150
(229) 433-8416
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
008065
GA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003225227A
—
GA
01
—
008065
STATE LICENSE NUMBER
GA
01
—
1143510
NCPDP NUMBER
GA
Enumeration date
11/10/2005
Last updated
09/02/2025
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