John Douglas Geerdes, D'MIN./LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MFT000892 Issued in GA

Practice address

19 Church St
Statesboro, GA 30458-5385

Phone

(912) 489-7590

Fax

(912) 489-7590

NPI assigned

Oct 25, 2007

Last updated

Jun 19, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Dr. John D. Geerdes II Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1193270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371600000000",
    "number": "1184803215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 CHURCH ST",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304585385",
            "telephone_number": "912-489-7590",
            "fax_number": "912-489-7590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 CHURCH ST",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304585385",
            "telephone_number": "912-489-7590",
            "fax_number": "912-489-7590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GEERDES",
        "first_name": "JOHN",
        "middle_name": "DOUGLAS",
        "name_prefix": "Dr.",
        "credential": "D'MIN./LMFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-25",
        "last_updated": "2013-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "GA",
            "license": "MFT000892",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "348418841A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "01359450",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "690643",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOHN",
            "last_name": "GEERDES",
            "middle_name": "D.",
            "prefix": "DR.",
            "suffix": "II",
            "credential": "D'MIN./LMFT",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Marriage & Family Therapist in Statesboro, GA
• Providers in Statesboro, GA by specialty
• Marriage & Family Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2013; 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.