Provider Demographics
NPI:1710635081
Name:SOUTH GEORGIA CAREER CENTER LLC
Entity Type:Organization
Organization Name:SOUTH GEORGIA CAREER CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN C-HCTC, CAHI
Authorized Official - Phone:229-288-5898
Mailing Address - Street 1:118 S MADISON ST STE 4
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-5400
Mailing Address - Country:US
Mailing Address - Phone:229-289-5898
Mailing Address - Fax:
Practice Address - Street 1:118 S MADISON ST STE 4
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5400
Practice Address - Country:US
Practice Address - Phone:229-289-5898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No291U00000XLaboratoriesClinical Medical Laboratory