Provider Demographics
NPI:1649384520
Name:SOUTH GEORGIA PHYSICIANS FOR WOMEN
Entity Type:Organization
Organization Name:SOUTH GEORGIA PHYSICIANS FOR WOMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-382-8822
Mailing Address - Street 1:PO BOX 1189
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-1189
Mailing Address - Country:US
Mailing Address - Phone:229-382-8822
Mailing Address - Fax:229-387-0377
Practice Address - Street 1:1006 GREENFIELD DR
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3794
Practice Address - Country:US
Practice Address - Phone:229-382-8822
Practice Address - Fax:229-387-0377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTAX ID
GA=========OtherTAX ID