Provider Demographics
NPI:1295918712
Name:SOUTH GA ORTHOPEDIC RESOURCES INC
Entity type:Organization
Organization Name:SOUTH GA ORTHOPEDIC RESOURCES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:PARSON
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:229-386-9829
Mailing Address - Street 1:1825 OLD OCILLA RD
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-1617
Mailing Address - Country:US
Mailing Address - Phone:229-386-9829
Mailing Address - Fax:229-386-9830
Practice Address - Street 1:1825 OLD OCILLA RD
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-1617
Practice Address - Country:US
Practice Address - Phone:229-386-9829
Practice Address - Fax:229-386-9830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA057062934AMedicaid
GA5633920001Medicare NSC