Organization
SOUTH GEORGIA MEDICINE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHIRLEY VICKERS CARRINGTON (BILLING MANAGER)
(229) 382-9338
Entity
Organization
Contact information
Practice address
1111 20TH ST E, TIFTON, GA 31794-3689
(229) 382-9338
(229) 382-4282
Mailing address
1111 20TH ST E, TIFTON, GA 31794-3689
(229) 382-9338
(229) 382-4282
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
021582
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1023084000
BCBS
GA
01
—
11D090618
CLIA
GA
05
—
300029134A
—
GA
01
—
CA5040
RAILROAD MEDICARE
GA
Enumeration date
12/05/2006
Last updated
06/21/2021
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