Provider Demographics
NPI:1699945154
Name:SOUTH GAORTHOPEDIC RESOURCES
Entity type:Organization
Organization Name:SOUTH GAORTHOPEDIC RESOURCES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHOTIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:D
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 1:127 ENTERPRISE PATH
Practice Address - Street 2:STE 403
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2697
Practice Address - Country:US
Practice Address - Phone:678-384-1921
Practice Address - Fax:678-384-1922
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH GEORGIA ORTHOPEDIC RESOURCES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-11
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5633920002Medicare NSC