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DSH110122A SOUTH GEORGIA MEDICAL CENTER (Active)
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Main Details
Name
SOUTH GEORGIA MEDICAL CENTER
Subdivision Name
THE SURGERY CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110122A
Medicare Provider Number
110122
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
5/29/2009
Participating Start Date
7/1/2009
Participating Approval Date
6/8/2009
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
SGMC
Ronald E Dean, CEO
(229) 259-4102
Primary Contact
SGMC
Scott Bruce Smith, Director of Pharmacy
(229) 259-4870
Addresses
Street Address
2417 NORTH PATTERSON STREET
VALDOSTA, GA 31602
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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