MH 102, PC (NPI# 1861056376) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861056376 |
| Entity Type | Organization |
| Organization Name | MH 102, PC |
| Practice Address |
1203 Brampton Ave Statesboro GA 30458-0850 |
| Mailing Address |
Po Box 5 Winooski VT 05404-0005 |
| Practice Telephone | 8028570400 |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2019-04-30 |
| Authorized Official Name | BEVERLEY RAYMOND (PRESIDENT) |
| Authorized Official Telephone | 8028570400 |
| Authorized Official Credential | NP |
| Is Organization Subpart | Y |
| Parent Organization Name | MH 102, PC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers |
| Other Name | Type Code |
|---|---|
| Briggs & Stratton Statesboro Health Center | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285268219 | Mh 102, PC | Nurse Practitioner | 1 Aflac Parkway, Columbus, GA 31907 | 2020-02-28 |
| 1457985590 | Mh 102, PC | Nurse Practitioner | 193 Tilley Dr, South Burlington, VT 05403-4440 | 2020-02-27 |
| 1831723964 | Mh 102, PC | Nurse Practitioner | 1932 Wynnton Rd, Columbus, GA 31999-0001 | 2020-02-27 |
| 1174157218 | Mh 102, PC | Nurse Practitioner | 813 E 68th St Ste B, Savannah, GA 31405-4710 | 2020-02-27 |
| 1457985509 | Mh 102, PC | Nurse Practitioner | 5204 Bernard Dr Ste 300a, Roanoke, VA 24018-4345 | 2020-02-27 |
| 1588298624 | Mh 102, PC | Nurse Practitioner | 817 Botetourt Ct Ste 106, Chesapeake, VA 23320-4886 | 2020-02-27 |
| 1285105171 | Mh 102, PC | Nurse Practitioner | 2322 Blue Stone Hills Dr Ste 260, Harrisonburg, VA 22801-5403 | 2018-12-17 |
| 1811476286 | Mh 102, PC | Nurse Practitioner | 1020 Barrow Industrial Pkwy, Winder, GA 30680-3891 | 2018-08-07 |
| 1689177040 | Mh 102, PC | Nurse Practitioner | 98 Alexandria Pike Ste 52, Warrenton, VA 20186-2849 | 2018-03-13 |
| 1720599657 | Mh 102, PC | Nurse Practitioner | 864 Spring St Nw, Atlanta, GA 30308-1007 | 2017-10-18 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oklahoma Business Registrations | MH 102, PC | Po Box 5, Winooski, VT 05404 |
| Street Address |
1203 BRAMPTON AVE |
| City | STATESBORO |
| State | GA |
| Zip Code | 30458-0850 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265480172 | Angela Sellers Gerguis | Family Medicine | 1203 Brampton Ave, Suite A, Statesboro, GA 30458-0850 | 2006-05-04 |
| 1316590847 | Julie Johnson | Nurse Practitioner | 1203 Brampton Ave, Statesboro, GA 30458-0850 | 2019-07-23 |
| 1871072983 | Meridian Corporate Healthcare of Georgia P C | Clinic/Center | 1203 Brampton Ave, Statesboro, GA 30458 | 2018-08-09 |
| 1063665834 | South Georgia Family Medicine Associates | Family Medicine | 1203 Brampton Ave, Statesboro, GA 30458-0850 | 2008-10-24 |
| 1336197250 | John S Gerguis | Family Medicine | 1203 Brampton Ave, Statesboro, GA 30458-0850 | 2006-05-04 |
| 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 | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962020057 | Shantera Clark | Nurse Practitioner | 630 Ogeechee Dr W, Statesboro, GA 30461-6753 | 2020-07-06 |
| 1194028977 | Statesboro Hma Medical Group, LLC | Nurse Practitioner | 16741 Highway 67, Suite A, Statesboro, GA 30458-2528 | 2010-12-16 |
| 1588104715 | Teresa Buckles | Nurse Practitioner | 106 Briarwood Rd, Statesboro, GA 30458-2459 | 2017-03-07 |
| 1033657333 | Qian Tang | Nurse Practitioner | 106 Briarwood Rd, Statesboro, GA 30458-2459 | 2017-02-07 |
| 1659725745 | Megan Elizabeth Marsh | Nurse Practitioner | 1 W Altman St, Statesboro, GA 30458-5212 | 2016-04-15 |
| 1386010478 | Wendy Futch | Nurse Practitioner | 1499 Fair Rd, Statesboro, GA 30458-1683 | 2015-08-12 |
| 1134524036 | Tristia Knight | Nurse Practitioner | 1499 Fair Rd, Statesboro, GA 30458-1683 | 2014-11-04 |
| 1104228402 | Karen Mcneely | Nurse Practitioner | 114 Hill Pond Ln, Statesboro, GA 30458-0872 | 2014-09-18 |
| 1912272675 | Jason Floyd Tucker | Nurse Practitioner | 1058 Bermuda Run, Statesboro, GA 30458-0858 | 2012-03-14 |
| 1265558118 | Georgia Southern University | Nurse Practitioner | 984 Plant Drive, Statesboro, GA 30460-0001 | 2007-03-22 |
| Find all providers in STATESBORO | ||||
| City | STATESBORO |
| Zip Code | 30458 |
Please comment or provide details below to improve the information on MH 102, PC.
| 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.