1. Home
  2. Directory
  3. Georgia
  4. Valdosta
  5. Pediatrics
  6. NPI Profile

SOUTHERN PEDIATRIC CLINIC, LLC
NPI 1982858767
Pediatrics in Valdosta, GA

Active since November 06, 2008CLIA Certified · 2 labs
406 M NORTHSIDE DRIVE, VALDOSTA, GA 31602(229) 241-0059(229) 241-0059 Get Directions Write a Review

NPPES record last updated: February 3, 2017. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Southern Pediatric Clinic, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHERN PEDIATRIC CLINIC, LLC (NPI 1982858767) is a healthcare organization registered as a pediatrics in Valdosta, Georgia and active in the NPI registry since November 2008. The organization holds 2 active CLIA laboratory certificates and lists Charlene C Blache, Owner/physician, as its authorized official.

NPPES Registry Identity

NPI1982858767
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameSOUTHERN PEDIATRIC CLINIC, LLC
Location Address406 M NORTHSIDE DRIVEValdosta, GA 31602
Mailing Address406 M Northside DriveValdosta, GA 31602 · (229) 241-0059 · Fax (229) 241-2088
Phone(229) 241-0059
Fax(229) 241-0059
Organization SubpartNo
Authorized OfficialCharlene C BlacheOwner/physician · (229) 241-0059
Enumeration DateNovember 6, 2008
Last NPPES UpdateFebruary 3, 2017
✔ NPI 1982858767 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
406 M NORTHSIDE DRIVE, Valdosta, GA 31602
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 11D2263798

Southern Pediatric Clinic Acute Care · Valdosta, GA
Active · expires Feb 29, 2028
CLIA Number11D2263798
Laboratory TypePhysician Office
Certificate Effective DateMarch 1, 2026
Certificate Expiration DateFebruary 29, 2028
Laboratory DirectorCharlene C. Blache
Laboratory Phone(229) 241-0059
Laboratory LocationSouthern Pediatric Clinic Acute Care207 Northside Drive, Valdosta, GA 31602
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate of Waiver 11D2003343

Southern Pediatric Clinic, LLC · Valdosta, GA
Active · expires Oct 2, 2026
CLIA Number11D2003343
Laboratory TypePhysician Office
Certificate Effective DateOctober 3, 2024
Certificate Expiration DateOctober 2, 2026
Laboratory DirectorCharlene Carla Blache
Laboratory Phone(229) 241-0059
Laboratory LocationSouthern Pediatric Clinic, LLC406 Northside Drive, Suite M, Valdosta, GA 31602
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. CHARLENE CARLA BLACHE M.D.
Pediatrics
406 M NORTHSIDE DRIVE
VALDOSTA, GA 31602
Lowndes County (229) 241-0059
MRS. SUSAN ELIZABETH MACKEY-BURNS N.P.
Nurse Practitioner (Pediatrics)
406 M NORTHSIDE DRIVE
VALDOSTA, GA 31602
Lowndes County (229) 241-0059
MRS. VIRGINIA PARRAMORE COCHRAN N.P.
Nurse Practitioner (Pediatrics)
406 M NORTHSIDE DRIVE
VALDOSTA, GA 31602
Lowndes County (229) 241-0059

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southern Pediatric Clinic, LLC's NPI number?

The NPI number for Southern Pediatric Clinic, LLC is 1982858767. It was assigned to this organization in the NPPES registry on November 6, 2008.

Where is Southern Pediatric Clinic, LLC located?

Southern Pediatric Clinic, LLC is located at 406 M Northside Drive, Valdosta, GA 31602. The listed phone number is (229) 241-0059.

What is Southern Pediatric Clinic, LLC's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Does Southern Pediatric Clinic, LLC hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Southern Pediatric Clinic, LLC accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama and Ambetter of North Carolina and 1 other insurer list Southern Pediatric Clinic, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Southern Pediatric Clinic, LLC was last updated on February 3, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.