Provider Demographics
NPI:1689738700
Name:SOUTH GEORGIA INTERNAL MEDICINE,PC
Entity Type:Organization
Organization Name:SOUTH GEORGIA INTERNAL MEDICINE,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRASAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-237-2527
Mailing Address - Street 1:544 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-3230
Mailing Address - Country:US
Mailing Address - Phone:478-237-2527
Mailing Address - Fax:478-237-7406
Practice Address - Street 1:544 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-3230
Practice Address - Country:US
Practice Address - Phone:478-237-2527
Practice Address - Fax:478-237-7406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6281Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION