GEORGIA SOUTHERN UNIVERSITY (NPI# 1265558118) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265558118 |
| Entity Type | Organization |
| Organization Name | GEORGIA SOUTHERN UNIVERSITY |
| Other Organization Name | GEORGIA SOUTHERN UNIVERSITY HEALTH SERVICES |
| Practice Address |
984 Plant Drive Statesboro GA 30460-0001 |
| Mailing Address |
Po Box 5199 Abilene TX 79608-5199 |
| Practice Telephone | 9124785641 |
| Practice Fax Number | 9124781893 |
| Mailing Telephone | 8668906390 |
| Mailing Fax Number | 3254378390 |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2018-02-05 |
| Authorized Official Name | DIANE NORRIS (DIRECTOR OF HEALTH SERVICES) |
| Authorized Official Telephone | 9124785641 |
| Is Organization Subpart | Y |
| Parent Organization Name | GEORGIA SOUTHERN UNIVERSITY |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LW0102X |
Nurse Practitioner Specialization: Women's Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Georgia Southern University Health Services | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558615096 | Georgia Southern University | Clinic/Center | 590 Herty Drive, Room 1216, Statesboro, GA 30458 | 2012-11-06 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | GEORGIA SOUTHERN UNIVERSITY | 1582 Southern Dr, Statesboro, GA 30458 |
| Colorado Business Entities | Georgia Southern University Athletic Foundation, Inc. | 203 Lanier Drive, Statesboro, GA 30458 |
| System for Award Management (SAM) Entities | GEORGIA SOUTHERN UNIVERSITY RESEARCH AND SERVICE FOUNDATION, INC. | 261 Forest Dr Ste 3000, Statesboro, GA 30458 |
| Street Address |
984 PLANT DRIVE |
| City | STATESBORO |
| State | GA |
| Zip Code | 30460-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841202868 | Brian Mixon Deloach | Family Medicine | 984 Plant Drive, Statesboro, GA 30460-0001 | 2006-08-12 |
| 1245635929 | Callaway Anderson Skinner | Physician Assistant | 984 Plant Drive, Statesboro, GA 30460-0001 | 2014-10-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760589683 | Andrea Elizabeth Bethel | Optometrist | 984 Plant Dr, Statesboro, GA 30460 | 2006-09-20 |
| 1699140855 | Amy Luna | Psychologist | 788 Forest Dr, Statesboro, GA 30460-0001 | 2015-12-14 |
| 1437559333 | Catherine Mcculley | Student in an Organized Health Care Education/Training Program | 590 Herty Dr, Statesboro, GA 30460-0001 | 2014-08-27 |
| 1851621080 | Shannon Kay Salter Fussell | Psychologist | Forest Dr, Counseling and Career Development Center, Statesboro, GA 30460-0001 | 2010-01-11 |
| 1255575890 | Georgia Southern University School of Nursing Community Nursing Center | Clinic/Center | 250 Forrest Dr, Rm# 1004, Statesboro, GA 30460-0001 | 2009-04-27 |
| 1194924449 | Thomas Andrew Buckley | Specialist/Technologist | Georgia Southern University, Health & Kinesiology, Statesboro, GA 30460-0001 | 2007-07-17 |
| 1831310721 | Brant Douglas Berkstresser | Specialist/Technologist | 50 Herty Dr, Hanner Fieldhouse, Georgia Southern University, Statesboro, GA 30460-0001 | 2007-05-01 |
| 1376764340 | Brandy Anne Petty | Physical Medicine & Rehabilitation | Georgia Southern University Hanner Fieldhouse, Herty Drive, Statesboro, GA 30460-0001 | 2007-05-01 |
| 1518010230 | Constance E Morgan | Nurse Practitioner | 0404 Forest Dr, Statesboro, GA 30460-0001 | 2007-01-18 |
| 1770670259 | Catherine K Dickens | Specialist | 0404 Forrest Dr, Georgia Southern University Health Services, Statesboro, GA 30460-0001 | 2006-10-06 |
| Find all providers in zip 30460 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942675863 | Southern Weight Loss Clinic, LLC | Family Medicine | 1098 Bermuda Run Ste 6, Statesboro, GA 30458-0878 | 2015-12-03 |
| 1174887004 | Iris Kalin Clark | Family Medicine | 1550 Brampton Ave, Ste B, Statesboro, GA 30458-0886 | 2012-06-26 |
| 1134439581 | Aaron Taylor Clark | Family Medicine | 117 Hill Pond Ln, Statesboro, GA 30458-0872 | 2010-10-19 |
| 1013245091 | Leslie Amanda Pittman | Family Medicine | 16741 Hwy 67, Suite A, Statesboro, GA 30458 | 2009-12-02 |
| 1528299393 | Southern Family Medicine of Georgia, LLC | Family Medicine | 1140 Brampton Ave, Statesboro, GA 30458 | 2009-07-28 |
| 1972684546 | Glen J. Dasher | Family Medicine | 1140 Brampton, Statesboro, GA 30458 | 2006-10-18 |
| 1821103482 | Christopher W Munger | Family Medicine | 23702 Hwy 80 East, Statesboro, GA 30458 | 2006-08-21 |
| 1841202868 | Brian Mixon Deloach | Family Medicine | 984 Plant Drive, Statesboro, GA 30460-0001 | 2006-08-12 |
| 1013921428 | Robert Moore Benson Jr. | Family Medicine | 4451 Country Club Rd, Suite 3a, Statesboro, GA 30458-9188 | 2006-07-28 |
| 1104874031 | Thaddeus H Riley | Family Medicine | 23702 Hwy 80 E, Statesboro, GA 30458 | 2006-05-04 |
| Find all providers in STATESBORO | ||||
| City | STATESBORO |
| Zip Code | 30460 |
Please comment or provide details below to improve the information on GEORGIA SOUTHERN UNIVERSITY.
| 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.