Provider Demographics
NPI:1366685307
Name:SOUTH HEALTH DISTRICT
Entity type:Organization
Organization Name:SOUTH HEALTH DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA
Authorized Official - Phone:229-333-5290
Mailing Address - Street 1:251 APPOMATTOX RD
Mailing Address - Street 2:
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-3757
Mailing Address - Country:US
Mailing Address - Phone:229-333-7585
Mailing Address - Fax:229-333-7591
Practice Address - Street 1:312 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-5526
Practice Address - Country:US
Practice Address - Phone:229-333-7585
Practice Address - Fax:229-333-7591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAFLU211OtherMEDICARE PART B
GA000052038BMedicaid