| Sgmc Affiliated Services LLC | |
|
2501 N Patterson St Valdosta GA 31602-1735 | |
| (229) 433-1000 | |
| Not Available |
| Full Name | Sgmc Affiliated Services LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 2501 N Patterson St, Valdosta, Georgia |
| Authorized Official Name and Position | Olaf Faeskorn (VP REVENUE CYCLE) |
| Authorized Official Contact | 2292594749 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sgmc Affiliated Services LLC Po Box 9 Valdosta GA 31603-0009 | Sgmc Affiliated Services LLC 2501 N Patterson St Valdosta GA 31602-1735 Ph: (229) 433-1000 |
| NPI Number | 1114740362 |
|---|---|
| Provider Enumeration Date | 11/06/2024 |
| Last Update Date | 11/04/2025 |
| Certification Date | 11/04/2025 |
| Medicare PECOS PAC ID | 5496284028 |
|---|---|
| Medicare Enrollment ID | O20250128002845 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114740362 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | () | Primary |
| 261QU0200X | Clinic/center - Urgent Care | () | Secondary |
| Provider Name | David R Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215079983 PECOS PAC ID: 8325937956 Enrollment ID: I20040312000173 |
| Provider Name | Leonard F Howard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841227923 PECOS PAC ID: 0244212207 Enrollment ID: I20040603000361 |
| Provider Name | Spencer Price |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1881612067 PECOS PAC ID: 8729061528 Enrollment ID: I20040614000116 |
| Provider Name | Wayne C Wright |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1639150741 PECOS PAC ID: 8628011491 Enrollment ID: I20050606000207 |
| Provider Name | Alan W Stout |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205878386 PECOS PAC ID: 3779511613 Enrollment ID: I20050801000987 |
| Provider Name | Winston C Connell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144370206 PECOS PAC ID: 2668572793 Enrollment ID: I20070703000039 |
| Provider Name | Cristi L Godwin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407824832 PECOS PAC ID: 5890859052 Enrollment ID: I20090203000208 |
| Provider Name | Russell L During |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1437381266 PECOS PAC ID: 8921145707 Enrollment ID: I20091027000796 |
| Provider Name | Thomas Marion Lott |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1255312146 PECOS PAC ID: 3173647708 Enrollment ID: I20100902000592 |
| Provider Name | Adam C Jones |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1346478542 PECOS PAC ID: 7012183940 Enrollment ID: I20111227000485 |
| Provider Name | Hale E Hedley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669406260 PECOS PAC ID: 7810917176 Enrollment ID: I20120723000584 |
| Provider Name | Keith W Munoz |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1437193927 PECOS PAC ID: 6406824556 Enrollment ID: I20120829000227 |
| Provider Name | Carl L Stalvey |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1841452968 PECOS PAC ID: 4385887975 Enrollment ID: I20130829000566 |
| Provider Name | Elizabeth Flail |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1548554124 PECOS PAC ID: 3870737000 Enrollment ID: I20140922001527 |
| Provider Name | Mesheal L Leverett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124420856 PECOS PAC ID: 6103149463 Enrollment ID: I20141218000820 |
| Provider Name | Margaret D Bishop |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1699179663 PECOS PAC ID: 7315262557 Enrollment ID: I20150211001191 |
| Provider Name | Melinda F Scott |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1487050084 PECOS PAC ID: 0345567749 Enrollment ID: I20150324001164 |
| Provider Name | Kathryn Woltz |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1548662505 PECOS PAC ID: 5799007555 Enrollment ID: I20160629001996 |
| Provider Name | Stacy Beck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730621582 PECOS PAC ID: 4385926492 Enrollment ID: I20170125002936 |
| Provider Name | Taylor N Fiveash |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962922427 PECOS PAC ID: 7618249558 Enrollment ID: I20170828001053 |
| Provider Name | Margaret C Carter-poore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235652421 PECOS PAC ID: 6507139136 Enrollment ID: I20170901002753 |
| Provider Name | Joseph Daniel Souders |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1316460736 PECOS PAC ID: 3678849288 Enrollment ID: I20171026002235 |
| Provider Name | Michelle Charles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437676491 PECOS PAC ID: 4183980139 Enrollment ID: I20171108002150 |
| Provider Name | Clayton Aaron Charles |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1083974679 PECOS PAC ID: 6204145246 Enrollment ID: I20171109001846 |
| Provider Name | Lila L Bennett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932620598 PECOS PAC ID: 5991061400 Enrollment ID: I20171115002335 |
| Provider Name | Jason a Swaby |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1366735102 PECOS PAC ID: 7810112232 Enrollment ID: I20171218002088 |
| Provider Name | Wesley B Roney |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1427008549 PECOS PAC ID: 3274566633 Enrollment ID: I20180928002328 |
| Provider Name | Jessica Alferink |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235627464 PECOS PAC ID: 7416209358 Enrollment ID: I20181004001062 |
| Provider Name | Janice L Irvin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760961155 PECOS PAC ID: 7719221126 Enrollment ID: I20181211002476 |
| Provider Name | Teresa Tripp Ford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023580420 PECOS PAC ID: 7810235710 Enrollment ID: I20190220000432 |
| Provider Name | Xenophon Mucciarone |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1801216007 PECOS PAC ID: 9830319565 Enrollment ID: I20190528000466 |
| Provider Name | Robert L. Green |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1558386706 PECOS PAC ID: 2264591544 Enrollment ID: I20190607002636 |
| Provider Name | Davis Page Lester |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1306208558 PECOS PAC ID: 4183917131 Enrollment ID: I20190819003634 |
| Provider Name | Brian R Pisula |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1477999126 PECOS PAC ID: 3577789387 Enrollment ID: I20190822002932 |
| Provider Name | Eric B Edgerton |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1700248788 PECOS PAC ID: 6406142934 Enrollment ID: I20190823003550 |
| Provider Name | Trevor Lawton Davis |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1629538822 PECOS PAC ID: 2860724333 Enrollment ID: I20191101002446 |
| Provider Name | Lindsey Lawhorn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992335855 PECOS PAC ID: 6204264641 Enrollment ID: I20200317002041 |
| Provider Name | Brad Jay Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639640436 PECOS PAC ID: 1850713199 Enrollment ID: I20200615003349 |
| Provider Name | Katie Repko Norris |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1619587110 PECOS PAC ID: 8426477951 Enrollment ID: I20201001001672 |
| Provider Name | John William Ledwitch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528116019 PECOS PAC ID: 0941611560 Enrollment ID: I20201202002149 |
| Provider Name | Tyler Tantisook |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1326545823 PECOS PAC ID: 4385055805 Enrollment ID: I20201204000394 |
| Provider Name | Cole Seaton |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1205331170 PECOS PAC ID: 8820419831 Enrollment ID: I20210324000324 |
| Provider Name | Robin M Stinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376108894 PECOS PAC ID: 3274866322 Enrollment ID: I20210803002453 |
| Provider Name | Paige Huston Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477129104 PECOS PAC ID: 7416351317 Enrollment ID: I20210813000492 |
| Provider Name | Grant P Barker |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1477013555 PECOS PAC ID: 4082956024 Enrollment ID: I20220221000669 |
| Provider Name | Julia H Goff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487309514 PECOS PAC ID: 0941697551 Enrollment ID: I20220429001119 |
| Provider Name | Jason Boyd Langley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194471060 PECOS PAC ID: 2668859497 Enrollment ID: I20220517003288 |
| Provider Name | Christopher Poore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871220525 PECOS PAC ID: 7315322112 Enrollment ID: I20220914003668 |
| Provider Name | Hunter L Clanton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447967575 PECOS PAC ID: 9032587266 Enrollment ID: I20221119000530 |
| Provider Name | Ginger Ambron |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881050375 PECOS PAC ID: 3779888383 Enrollment ID: I20230214000347 |
| Provider Name | David Garcia |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1356873871 PECOS PAC ID: 1759768237 Enrollment ID: I20230628002149 |
| Provider Name | Gary-wayne Luke Collins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164205183 PECOS PAC ID: 1254794142 Enrollment ID: I20230824003053 |
| Provider Name | Carmen Vincent Duncan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659154011 PECOS PAC ID: 9234583733 Enrollment ID: I20231003001330 |
| Provider Name | Carter Adams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497535637 PECOS PAC ID: 8628411840 Enrollment ID: I20240205002893 |
| Provider Name | Bradley John Kinney |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1851662936 PECOS PAC ID: 5496189300 Enrollment ID: I20240717000878 |
| Provider Name | Charmaine Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619723160 PECOS PAC ID: 0648717207 Enrollment ID: I20240801001256 |
| Provider Name | Nicholas Cowell |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1235632001 PECOS PAC ID: 7315294360 Enrollment ID: I20250423000139 |
| Provider Name | Kaitlyn Marie Daniels |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1619634896 PECOS PAC ID: 3375934318 Enrollment ID: I20250506003191 |
| Provider Name | Ryan Reynolds |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245718295 PECOS PAC ID: 2860744638 Enrollment ID: I20250509002721 |
| Provider Name | Jessica Lynn Otto |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497196158 PECOS PAC ID: 1850526633 Enrollment ID: I20250827003621 |
| Provider Name | Matthew Hamrick |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1801391925 PECOS PAC ID: 3577949908 Enrollment ID: I20250924004423 |
| Provider Name | Alex Hughes |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1891070991 PECOS PAC ID: 9436655347 Enrollment ID: I20250930003489 |
| Provider Name | Jasmine Loving Dawson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770294407 PECOS PAC ID: 2961992581 Enrollment ID: I20251103003173 |
| Provider Name | Beverly Kirk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588803092 PECOS PAC ID: 5193042125 Enrollment ID: I20251107004633 |
| Provider Name | Sarah Straka |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306642657 PECOS PAC ID: 8527581792 Enrollment ID: I20251110003038 |
| Provider Name | Jason Hirsch |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1831911825 PECOS PAC ID: 1052890415 Enrollment ID: I20260206001095 |
Joseph S Thomas M D Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 410 Connell Rd, Ste T, Valdosta, GA 31602 Phone: 229-242-9565 Fax: 229-242-1725 |
Care Medical Center LLC Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2804 N Oak St, Suite C, Valdosta, GA 31602 Phone: 229-241-8925 Fax: 229-241-7672 |
Griner Medical Group Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3301 N Oak Street Ext, Valdosta, GA 31605 Phone: 229-242-6061 Fax: 229-242-6151 |
Valdosta Medical Associates Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3300 Greystone Way, Valdosta, GA 31605 Phone: 229-247-7700 |
Valdosta Gastroenterology Associates, LLC Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 410 Connell Rd, Valdosta, GA 31602 Phone: 229-244-1570 Fax: 229-247-1084 |
Partnership Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 520 Griffin Ave, Valdosta, GA 31601 Phone: 229-245-0020 Fax: 229-245-9855 |