STATESBORO MEDICAL GROUP, LLC (NPI# 1013535657) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013535657 |
| Entity Type | Organization |
| Organization Name | STATESBORO MEDICAL GROUP, LLC |
| Other Organization Name | STATESBORO URGENT CARE |
| Practice Address |
1176 Brampton Ave Statesboro GA 30458-0847 |
| Mailing Address |
106 Irongate Pl Statesboro GA 30458-9173 |
| Practice Telephone | 9122599474 |
| Mailing Telephone | 9125317338 |
| Enumeration Date | 2020-07-09 |
| Last Update Date | 2020-09-11 |
| Authorized Official Name | DR. SREEVALLI DEGA (OWNER) |
| Authorized Official Telephone | 9122599474 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QU0200X |
Clinic/Center Specialization: Urgent Care |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | NPI | 1023247731 | 01 |
| GA | NPI | 1023247723 | 01 |
| Other Name | Type Code |
|---|---|
| Statesboro urgent care | Doing Business As Name - Organization |
| Street Address |
1176 BRAMPTON AVE |
| City | STATESBORO |
| State | GA |
| Zip Code | 30458-0847 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639642218 | Youtherapy | Counselor | 430 Northside Dr East, Suite 160 Mb326, Statesboro, GA 30458 | 2019-01-07 |
| 1053891853 | Alexandria Franklin | Specialist/Technologist | 1332 Southern Dr, Statesboro, GA 30458 | 2018-08-21 |
| 1740780006 | Michael Ryan Clark | Pharmacist | 556 Northside Drive, Statesboro, GA 30458 | 2018-02-13 |
| 1689186405 | Chandler James Herman | Specialist/Technologist | 590 Herty Dr., Statesboro, GA 30458 | 2017-11-02 |
| 1477009181 | Mama Doc Pediatrics, LLC | Pediatrics | 400 East Grady Street, Statesboro, GA 30458 | 2016-09-01 |
| 1053761171 | Rebekah Roessler | Specialist/Technologist | 2687 Akins Blvd, Statesboro, GA 30458 | 2016-06-20 |
| 1427412253 | Refocus Counseling and Consulting Services | Community/Behavioral Health | 4325 Country Club, 4, Statesboro, GA 30458 | 2016-04-07 |
| 1023408523 | Kacy H. Nesmith | Nurse Practitioner | 1098 Bermuda Run, Suite 6, Statesboro, GA 30458 | 2015-02-04 |
| 1760870398 | Jessica Pasternack | Specialist/Technologist | 2687 Akins Boulevard, Statesboro, GA 30458 | 2015-01-06 |
| 1922401629 | Nathan D'amico | Student in an Organized Health Care Education/Training Program | 15 W Grady Street Unit A, Statesboro, GA 30458 | 2014-10-08 |
| Find all providers in zip 30458 | ||||
| Taxonomy Code | 261QU0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Urgent Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134559396 | Applecare LLC | Clinic/Center | 586 Brannen St, Statesboro, GA 30458-5557 | 2013-11-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427662741 | Rural Urgent Care LLC | Clinic/Center | 125 Benjamin H Hill Dr. Sw, Fitzgerald, GA 31750 | 2020-09-03 |
| 1699388231 | Reagan Medical Center | Clinic/Center | 426 Exchange Blvd Ste 500, Bethlehem, GA 30620-1797 | 2020-08-24 |
| 1982214888 | Emergent Testing LLC | Clinic/Center | 2566 Shallowford Rd Ne Ste 204, Atlanta, GA 30345-1249 | 2020-08-05 |
| 1154931541 | The Urgent Care Center of Richmond Hill, LLC | Clinic/Center | 818 Abercorn St, Savannah, GA 31401-5933 | 2020-07-31 |
| 1346858255 | Castellum Medical Consultants LLC | Clinic/Center | 1618 Mars Hill Rd Ste A, Watkinsville, GA 30677-4847 | 2020-07-16 |
| 1861010423 | Rural Urgent Care LLC | Clinic/Center | 440 Us Highway 84 E, Cairo, GA 39828-1647 | 2020-07-10 |
| 1083249114 | Medlife Urgent Care LLC | Clinic/Center | 345 Huntington Place Ct Ste 200, Mcdonough, GA 30253-8651 | 2020-03-09 |
| 1376173906 | Rural Urgent Care LLC | Clinic/Center | 1408 Tallahassee Hwy Ste Z, Bainbridge, GA 39819-7791 | 2020-01-23 |
| 1942846100 | Pickens Urgent Care LLC | Clinic/Center | 744 Noah Dr Ste 108-109, Jasper, GA 30143-8705 | 2019-11-22 |
| 1457995045 | Reagan Urgent Care | Clinic/Center | 2878 Five Forks Trickum Rd Ste 2a, Lawrenceville, GA 30044 | 2019-11-06 |
| Find all providers with the same taxonomy | ||||
| City | STATESBORO |
| Zip Code | 30458 |
Please comment or provide details below to improve the information on STATESBORO MEDICAL GROUP, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.