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DSH110122B SOUTH GEORGIA MEDICAL CENTER (Terminated)
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Main Details
Name
SOUTH GEORGIA MEDICAL CENTER
Subdivision Name
Health Care South
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110122B
Medicare Provider Number
110122
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/11/2013
Participating Start Date
1/1/2014
Participating Approval Date
12/5/2013
Last Recertification Date
9/4/2015
Termination Date
Termination Reason
10/1/2015
Other
Contacts
Authorizing Official
SGMC
Ronald E Dean, CEO
(229) 259-4102
Primary Contact
Cindy Vickery, Director of Pharmacy
(229) 259-4870
Addresses
Street Address
250 Griffin Avenue
Valdosta, GA 31602
Billing Address
South Georgia Medical Center
PO BOX 0070
Valdosta, GA 31603-0070
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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