SOUTHERN FAMILY MEDICINE OF GEORGIA, LLC (NPI# 1528299393) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528299393 |
| Entity Type | Organization |
| Organization Name | SOUTHERN FAMILY MEDICINE OF GEORGIA, LLC |
| Other Organization Name | SOUTHERN FAMILY MEDICINE LLC |
| Practice Address |
1140 Brampton Ave Statesboro GA 30458 |
| Practice Telephone | 9128712273 |
| Practice Fax Number | 9128723374 |
| Mailing Telephone | 9128712273 |
| Mailing Fax Number | 9128712274 |
| Enumeration Date | 2009-07-28 |
| Last Update Date | 2019-08-09 |
| Authorized Official Name | CINDY R RUSH (BILLING MANAGER) |
| Authorized Official Telephone | 9122905235 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 43354 | GA | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Southern Family Medicine LLC | Other Name - Individual/Organization |
| Tri-Care Family Medicine LLC | Former Legal Business Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 308 E Long St, Claxton, GA 304171412 | 9122905235 | 9122905236 |
| Street Address |
1140 BRAMPTON AVE |
| City | STATESBORO |
| State | GA |
| Zip Code | 30458 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366723710 | Matthew Phillips | Family Medicine | 1140 Brampton Ave, Statesboro, GA 30458 | 2011-08-30 |
| 1336434992 | Luke Daniel Krautter | Family Medicine | 1140 Brampton Ave, Statesboro, GA 30458 | 2011-06-12 |
| 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 | 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 |
| 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 |
| 1265480172 | Angela Sellers Gerguis | Family Medicine | 1203 Brampton Ave, Suite A, Statesboro, GA 30458-0850 | 2006-05-04 |
| Find all providers in STATESBORO | ||||
| City | STATESBORO |
| Zip Code | 30458 |
Please comment or provide details below to improve the information on SOUTHERN FAMILY MEDICINE OF GEORGIA, 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.