East Georgia Nephrology, PC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

034372 Issued in GA

Legal business name

EAST GEORGIA NEPHROLOGY, PC

Practice address

450 Georgia Ave
Suite B
Statesboro, GA 30458-5585

Phone

(912) 871-2200

Fax

(912) 871-2220

NPI assigned

Aug 6, 2007

Last updated

Nov 6, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

James William Jackson Jr., MDNPI 1467547836

Title

Owner

Phone

(912) 871-2200

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 5

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.

• James W Jackson Jr., MD

  • Nephrology Physician
  • Statesboro, GA
  • NPI 1467547836
  Medicare reassignment NPD Authorized official
• Melissa Beasley, NP

  • Family Nurse Practitioner
  • Statesboro, GA
  • NPI 1700259108
  NPD (past)
• Maryn Clements Chandler, PA-C

  • Medical Physician Assistant
  • Statesboro, GA
  • NPI 1053672709
  NPD (past)
• Mai Fujimoto

  • Acute Care Nurse Practitioner
  • Statesboro, GA
  • NPI 1205755295
  NPD (past)
• Deidres Higgins, P.A.

  • Medical Physician Assistant
  • Fort Gordon, GA
  • NPI 1245389253
  NPD (past)

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

{
    "created_epoch": "1186358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446768000000",
    "number": "1215128186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 GEORGIA AVE",
            "address_2": "SUITE B",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304585585",
            "telephone_number": "912-871-2200",
            "fax_number": "912-871-2220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 GEORGIA AVE",
            "address_2": "SUITE B",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304585585",
            "telephone_number": "912-871-2200",
            "fax_number": "912-871-2220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST GEORGIA NEPHROLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-06",
        "last_updated": "2015-11-06",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-871-2200",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "GA",
            "license": "034372",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300034644A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DN3298",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• East Georgia Healthcare Center Inc (Statesboro Pediatrics & Family Healthcare)
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• East Georgia Hma Physician Management, LLC
• East Georgia Medical Assoc. P C
• East Georgia Oral & Maxillofacial Surgery Center
• East Georgia Orthopedic Center, PC.
• East Georgia Pediatrics
• East Georgia Radiology LLC
• East Georgia Regional Medical Center, LLC

• Nephrology Physician in Statesboro, GA
• Providers in Statesboro, GA by specialty
• Nephrology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.