Provider Demographics
NPI:1710383526
Name:GEORGIA PHYSICIANS SOUTH, P.C.
Entity Type:Organization
Organization Name:GEORGIA PHYSICIANS SOUTH, P.C.
Other - Org Name:BLACKSHEAR FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TANNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLIGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-462-8920
Mailing Address - Street 1:PO BOX 1005
Mailing Address - Street 2:
Mailing Address - City:NAHUNTA
Mailing Address - State:GA
Mailing Address - Zip Code:31553-1005
Mailing Address - Country:US
Mailing Address - Phone:912-462-8920
Mailing Address - Fax:912-462-5184
Practice Address - Street 1:71 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:NAHUNTA
Practice Address - State:GA
Practice Address - Zip Code:31553-4032
Practice Address - Country:US
Practice Address - Phone:912-462-8920
Practice Address - Fax:912-462-5184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health