Provider Demographics
NPI:1134316920
Name:SOUTH GEORGIA ORTHOPEDICS, P.C.
Entity Type:Organization
Organization Name:SOUTH GEORGIA ORTHOPEDICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:DERRY
Authorized Official - Last Name:CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:229-247-2482
Mailing Address - Street 1:2310 N PATTERSON ST
Mailing Address - Street 2:BLD. D
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2568
Mailing Address - Country:US
Mailing Address - Phone:229-247-2482
Mailing Address - Fax:229-247-0827
Practice Address - Street 1:2310 N PATTERSON ST
Practice Address - Street 2:BLD. D
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2568
Practice Address - Country:US
Practice Address - Phone:229-247-2482
Practice Address - Fax:229-247-0827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA29316261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty