East Georgia Pediatrics

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

EAST GEORGIA PEDIATRICS

Practice address

715 Northside Dr E
Suite 5 PMB 398
Statesboro, GA 30458-4712

Phone

(912) 489-3325

Fax

(912) 764-4977

NPI assigned

Jul 14, 2008

Last updated

Jul 14, 2008By 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

Dr. Michael Deal, MDNPI 1669538815

Title

Owner

Phone

(912) 489-3325

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

Practitioners 4

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.

• Michael C Deal, M.D.

  • Pediatrics Physician
  • Statesboro, GA
  • NPI 1669538815
  NPD (past) Authorized official
• Rachel Oglesby Edenfield, PNP

  • Pediatric Nurse Practitioner
  • Statesboro, GA
  • NPI 1659884237
  NPD (past)
• Danielle Nicole Gaspard, FNP-BC

  • Family Nurse Practitioner
  • Statesboro, GA
  • NPI 1063167914
  NPD (past)
• Taylor Bishop Pinkus, CPNP-AC/PC

  • Acute Care Nurse Practitioner
  • Savannah, GA
  • NPI 1336755289
  NPD (past)

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

{
    "created_epoch": "1215993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215993600000",
    "number": "1295999795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 N COLLEGE ST",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304585387",
            "telephone_number": "912-489-3325",
            "fax_number": "912-764-4977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 NORTHSIDE DR E",
            "address_2": "SUITE 5 PMB 398",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304584712",
            "telephone_number": "912-489-3325",
            "fax_number": "912-764-4977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST GEORGIA PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-14",
        "last_updated": "2008-07-14",
        "status": "A",
        "authorized_official_last_name": "DEAL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-489-3325",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "10051619",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000372391G",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "354428",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• East Georgia Hma Physician Management, LLC
• East Georgia Medical Assoc. P C
• East Georgia Nephrology, PC
• East Georgia Oral & Maxillofacial Surgery Center
• East Georgia Orthopedic Center, PC.
• East Georgia Radiology LLC
• 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

• Specialist in Statesboro, GA
• Providers in Statesboro, GA by specialty
• Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2008; 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.