East Georgia Radiology LLC
Organization Active NPI Diagnostic Radiology Physician · Statesboro, GA
NPI 1003973207 · NPPES record last updated Apr 30, 2025
Key facts
- NPI
- 1003973207
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- 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
- Organization subpart
- No
Authorized official
- Name
- Khoa D Nguyen, MD
- Title
- Senior Partner
- Phone
- (912) 486-1339
Practitioners 51
-
David J Bodne, MD
-
Colin A. Dodds, M.D
-
Janine M Dodds, MD
-
Nicholas Levi Henson, M.D.
-
Khoa D Nguyen, MD
-
Kathryn Cambron, MD
-
Le Yu Chiu, MD
-
Eugene P Chung, M.D.
-
Nidal I Dabbasi, M.D.
-
Jason R. Divito, D.O.
-
Douglas Allen Green, M.D., PH.D.
-
Amir Hedayati, M.D.
-
Waheed Jalalzai, M.D.
-
Kimia Khalatbari Kani, M.D.
-
Jarret Kuo, MD
-
David Su-Sien Lin, M.D.
-
Juan A. Lopez, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (22 enrollments) in GA, FL, CO, TX, PA, DC, CA, WA, NE, AZ, NM, TN, MO, OH, MA, NC, SC, IA, NH, NV, AL, MD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070306000531 | GA | Part B Supplier - Clinic/Group Practice | 7315040698 |
Receives reassigned benefits from 9 practitioners Practice locations: Louisville, GA; Statesboro, GA; Savannah, GA; Ellerslie, GA; Brooks, GA |
| O20250210000953 | FL | Part B Supplier - Clinic/Group Practice | 7315040698 |
Receives reassigned benefits from 4 practitioners Practice locations: Enterprise, FL; Miami, FL; Tampa, FL; Windermere, FL |
| O20250210001991 | CO | Part B Supplier - Clinic/Group Practice | 7315040698 |
Receives reassigned benefits from 1 practitioner Practice locations: Monument, CO |
| O20250210003560 | TX | Part B Supplier - Clinic/Group Practice | 7315040698 |
Receives reassigned benefits from 3 practitioners Practice locations: Keller, TX; Sugar Land, TX |
| O20250213003334 | PA | Part B Supplier - Clinic/Group Practice | 7315040698 |
Receives reassigned benefits from 3 practitioners Practice locations: Ambler, PA; Newtown Square, PA; Wynnewood, PA |
| O20250217000048 | DC | Part B Supplier - Clinic/Group Practice | 7315040698 |
Receives reassigned benefits from 2 practitioners Practice locations: Arlington, VA |
| O20250218001500 | CA | Part B Supplier - Clinic/Group Practice | 7315040698 |
Receives reassigned benefits from 4 practitioners Practice locations: Danville, CA; San Dimas, CA; San Francisco, CA; Seal Beach, CA; Temecula, CA |
| O20250220001897 | WA | Part B Supplier - Clinic/Group Practice | 7315040698 |
Receives reassigned benefits from 7 practitioners Practice locations: Seattle, WA; Leavenworth, WA; Kirkland, WA; Bellingham, WA; Clyde Hill, WA; Anacortes, WA; Bellevue, WA |
| O20250304003808 | NE | Part B Supplier - Clinic/Group Practice | 7315040698 |
Receives reassigned benefits from 1 practitioner Practice locations: Ashland, NE |
| O20250305002601 | AZ | Part B Supplier - Clinic/Group Practice | 7315040698 |
Receives reassigned benefits from 5 practitioners Practice locations: Peoria, AZ; Phoenix, AZ; Rio Verde, AZ; Scottsdale, AZ |
| O20250307003447 | NM | Part B Supplier - Clinic/Group Practice | 7315040698 |
Receives reassigned benefits from 1 practitioner Practice locations: Albuquerque, NM |
| O20250311001176 | TN | Part B Supplier - Clinic/Group Practice | 7315040698 |
Receives reassigned benefits from 2 practitioners Practice locations: Knoxville, TN; Signal Mountain, TN |
| O20250313002914 | MO | Part B Supplier - Clinic/Group Practice | 7315040698 |
Receives reassigned benefits from 1 practitioner Practice locations: Jackson, MO |
| O20250318002791 | OH | Part B Supplier - Clinic/Group Practice | 7315040698 |
Receives reassigned benefits from 1 practitioner Practice locations: Maumee, OH |
| O20250326000942 | MA | Part B Supplier - Clinic/Group Practice | 7315040698 |
Receives reassigned benefits from 1 practitioner Practice locations: Amherst, MA |
| O20251016004531 | NC | Part B Supplier - Clinic/Group Practice | 7315040698 |
Receives reassigned benefits from 2 practitioners Practice locations: Charlotte, NC; Durham, NC |
| O20251020001394 | SC | Part B Supplier - Clinic/Group Practice | 7315040698 |
Receives reassigned benefits from 1 practitioner Practice locations: Simpsonville, SC |
| O20251216000294 | IA | Part B Supplier - Clinic/Group Practice | 7315040698 |
Receives reassigned benefits from 1 practitioner Practice locations: Mason City, IA |
| O20260305002393 | NH | Part B Supplier - Clinic/Group Practice | 7315040698 |
Receives reassigned benefits from 1 practitioner Practice locations: Stratham, NH |
| O20260327000874 | NV | Part B Supplier - Clinic/Group Practice | 7315040698 |
Receives reassigned benefits from 1 practitioner Practice locations: Henderson, NV |
| O20260414003330 | AL | Part B Supplier - Clinic/Group Practice | 7315040698 |
Receives reassigned benefits from 1 practitioner Practice locations: Mountain BRK, AL |
| O20260417001823 | MD | Part B Supplier - Clinic/Group Practice | 7315040698 |
Receives reassigned benefits from 1 practitioner Practice locations: Lutherville, MD |
National Provider Directory
Locations
545 3rd St
Unit 3
Monument, CO 80132
110 Goshen Rd
Rincon, GA 31326
Phone (912) 826-1400
613 Towne Park Dr W
Ste 104
Rincon, GA 31326
Phone (912) 826-6015
Specialties & licenses
| 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 | Yes | ||
| 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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548254436 | Other | NPI DR GEORGE PIROS | |
| DF4636 | Other | RAILROAD MEDICARE | |
| 1821082421 | Other | NPI DR NGUYEN | |
| 972144316B | Medicaid | GA |
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
- East Georgia Urgent Care
- East Georgia Urologic Clinic, PC
- East Georgia Womens Center
All providers in Statesboro, GA · Diagnostic Radiology Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 30, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.