| Organization Name: | SOUTH GEORGIA VASCULAR CLINIC |
| NPI Number: | 1144454059 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DENNIS CRUM (VP/CFO) |
| Mailing Address: | 901 18th St E Tifton |
| State: | GA US |
| Postal Code: | 317943648 |
| Phone Number: | 2293829733 |
| Fax Number: | 2293876161 |
| NPI Enumeration Date: | 05/06/2009 |
| NPI Last Update Date: | 05/06/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2086S0129X |
| License Number: | 031466 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Surgery |
| Taxonomy Specialization: | Vascular Surgery |
| Taxonomy Definition: | A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |