Active NPI
East Georgia Radiology LLC
- Diagnostic Radiology Physician
- Statesboro, GA
National Provider Identifier
1003973207
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- Legal business name
- EAST GEORGIA RADIOLOGY LLC
- Practice address
- 1499 Fair Rd
Statesboro, GA 30458-1683 - Phone
- (912) 486-1339
- Fax
- (912) 871-2424
- NPI assigned
- Jan 3, 2007
- Last updated
- Apr 30, 2025
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Khoa D Nguyen, MD
- Title
- Senior Partner
- Phone
- (912) 486-1339
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 7
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Body Imaging Physician | 2085B0100X | |||
| Neuroradiology Physician | 2085N0700X | |||
| Nuclear Radiology Physician | 2085N0904X | |||
| Pediatric Radiology Physician | 2085P0229X | |||
| Diagnostic Radiology Physician | 2085R0202X | Primary | ||
| Vascular & Interventional Radiology Physician | 2085R0204X | |||
| Diagnostic Ultrasound Physician | 2085U0001X |
Addresses
Primary practice location
1499 Fair Rd
Statesboro, GA 30458-1683
Mailing address
PO Box 1368
Statesboro, GA 30459
Phone (912) 486-1339
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA, FL, CO, TX, PA, DC, CA, WA, NE, AZ, NM, TN, MO, OH, MA, NC, SC, IA, NH, NV, AL, MD
Enrollment records 22
National Provider Directory
National Provider DirectoryLocations
545 3rd St
Unit 3
Monument, CO 80132
613 Towne Park Dr W
Ste 104
Rincon, GA 31326
Phone (912) 826-6015
Practitioners & affiliated clinicians
Practitioners 51
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Diagnostic Radiology Physician
- Brooks, GA
- NPI 1316944697
-
- Vascular & Interventional Radiology Physician
- Savannah, GA
- NPI 1023012010
Diagnostic Radiology
-
- Diagnostic Radiology Physician
- Statesboro, GA
- NPI 1851590186
-
- Diagnostic Radiology Physician
- Savannah, GA
- NPI 1356326557
-
- Diagnostic Radiology Physician
- Columbus, GA
- NPI 1255599825
-
- Diagnostic Radiology Physician
- Stanford, CA
- NPI 1457812042
-
- Diagnostic Radiology Physician
- Northampton, MA
- NPI 1407893738
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167782400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1745971200000",
"number": "1003973207",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1368",
"city": "STATESBORO",
"state": "GA",
"postal_code": "30459",
"telephone_number": "912-486-1339",
"fax_number": "912-871-2424"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1499 FAIR RD",
"city": "STATESBORO",
"state": "GA",
"postal_code": "304581683",
"telephone_number": "912-486-1339",
"fax_number": "912-871-2424"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EAST GEORGIA RADIOLOGY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-03",
"last_updated": "2025-04-30",
"certification_date": "2025-04-30",
"status": "A",
"authorized_official_last_name": "NGUYEN",
"authorized_official_first_name": "KHOA",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "SENIOR PARTNER",
"authorized_official_telephone_number": "912-486-1339",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "2085B0100X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Radiology, Body Imaging",
"state": null,
"license": null,
"primary": false
},
{
"code": "2085N0700X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Radiology, Neuroradiology",
"state": null,
"license": null,
"primary": false
},
{
"code": "2085N0904X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Radiology, Nuclear Radiology",
"state": null,
"license": null,
"primary": false
},
{
"code": "2085P0229X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Radiology, Pediatric Radiology",
"state": null,
"license": null,
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Radiology, Diagnostic Radiology",
"state": null,
"license": null,
"primary": true
},
{
"code": "2085R0204X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Radiology, Vascular & Interventional Radiology",
"state": null,
"license": null,
"primary": false
},
{
"code": "2085U0001X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Radiology, Diagnostic Ultrasound",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Statesboro, GA
- East Georgia Medical Assoc. P C
- East Georgia Nephrology, PC
- East Georgia Oral & Maxillofacial Surgery Center
- East Georgia Orthopedic Center, PC.
- East Georgia Pediatrics
- East Georgia Regional Medical Center, LLC
- East Georgia Regional Medical Center, LLC (Statesboro Imaging Center)
- East Georgia Regional Medical Center, LLC
- East Georgia Urgent Care
- East Georgia Urologic Clinic, PC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.