NPIMap

Organization Active NPI

Smith & Purvis Family Practice Clinic, PC

Doing business as Statesboro Family Practice Clinic

  • Family Medicine Physician
  • Statesboro, GA
National Provider Identifier
1043384183
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
18745 Issued in GA
Legal business name
SMITH & PURVIS FAMILY PRACTICE CLINIC, PC
Doing business as
Statesboro Family Practice Clinic
Practice address
412 Northside Dr E
Suite 200
Statesboro, GA 30458-4802
Phone
(912) 764-9684
Fax
(912) 489-8676
NPI assigned
Nov 20, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Teri S Daigneault, CPC
Title
Medical Coder
Phone
(912) 764-1039

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 18745 GA Primary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 029847 GA
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 048703 GA

Addresses

Primary practice location

412 Northside Dr E
Suite 200
Statesboro, GA 30458-4802

Mailing address

412 Northside Dr E
Suite 200
Statesboro, GA 30458-4802
Phone (912) 764-9684

Other names 1

  • Statesboro Family Practice Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

658 Northside Dr E
Ste A
Statesboro, GA 30458
Phone (912) 764-9684

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043384183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 NORTHSIDE DR E",
            "address_2": "SUITE 200",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304584802",
            "telephone_number": "912-764-9684",
            "fax_number": "912-489-8676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 NORTHSIDE DR E",
            "address_2": "SUITE 200",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304584802",
            "telephone_number": "912-764-9684",
            "fax_number": "912-489-8676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMITH & PURVIS FAMILY PRACTICE CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DAIGNEAULT",
        "authorized_official_first_name": "TERI",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MEDICAL CODER",
        "authorized_official_telephone_number": "912-764-1039",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "18745",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "029847",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "048703",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Statesboro Family Practice Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Statesboro, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.