Provider Demographics
NPI:1437011624
Name:SOUTH GEORGIA MENTAL HEALTHCARE, LLC
Entity type:Organization
Organization Name:SOUTH GEORGIA MENTAL HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LPC
Authorized Official - Prefix:MS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:229-392-9000
Mailing Address - Street 1:302 S GRANT ST
Mailing Address - Street 2:
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-2914
Mailing Address - Country:US
Mailing Address - Phone:229-392-9000
Mailing Address - Fax:478-210-1009
Practice Address - Street 1:302 S GRANT ST
Practice Address - Street 2:
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750-2914
Practice Address - Country:US
Practice Address - Phone:229-392-9000
Practice Address - Fax:478-210-1009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-26
Last Update Date:2025-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty