Provider Demographics
NPI:1629731617
Name:SOUTHERN GEORGIA REGIONAL COMMISSION
Entity Type:Organization
Organization Name:SOUTHERN GEORGIA REGIONAL COMMISSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRIBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-285-6097
Mailing Address - Street 1:1725 S GEORGIA PKWY W
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31503-0169
Mailing Address - Country:US
Mailing Address - Phone:912-285-6097
Mailing Address - Fax:912-285-6126
Practice Address - Street 1:1725 S GEORGIA PKWY W
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31503-0169
Practice Address - Country:US
Practice Address - Phone:912-285-6097
Practice Address - Fax:912-285-6126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care