East Georgia Hma Physician Management, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

EAST GEORGIA HMA PHYSICIAN MANAGEMENT, LLC

Practice address

1497 Fair Rd
Statesboro, GA 30458-0822

Phone

(912) 486-1710

NPI assigned

Dec 9, 2009

Last updated

Nov 4, 2025By 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

Jennifer L Jackson

Title

Sr Dir Prov Enrollment

Phone

(615) 465-7000

Specialties & licenses 13

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• East Georgia Regional Medical Center, LLC

  • General Acute Care Hospital
  • Statesboro, GA
  • NPI 1265486278

  Member Of

  NPD member

Locations

Practitioners 58

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.

• John Michael Allen, M.D.

  • Surgery Physician
  • Lagrange, GA
  • NPI 1912142720
  Medicare reassignment Care Compare group NPD
• Tarek Amoun, MD

  • Pulmonary Disease Physician
  • Statesboro, GA
  • NPI 1487176327
  Medicare reassignment Care Compare group NPD
• Rosa M Austin, FNP

  • Family Nurse Practitioner
  • Statesboro, GA
  • NPI 1831491091
  Medicare reassignment Care Compare group NPD
• Basil Sohail Bangash

  • Pulmonary Disease Physician
  • Statesboro, GA
  • NPI 1144750571

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Robert Moore Benson Jr., MD

  • Family Medicine Physician
  • Statesboro, GA
  • NPI 1013921428
  Medicare reassignment Care Compare group NPD
• Carla S. Branch, M.D.

  • Family Medicine Physician
  • Statesboro, GA
  • NPI 1851394969
  Medicare reassignment Care Compare group NPD
• Andrew Vincent Cichelli, MD

  • Pulmonary Disease Physician
  • Statesboro, GA
  • NPI 1710044557
  Medicare reassignment Care Compare group NPD
• Shelly Clary, FNP-BC

  • Family Nurse Practitioner
  • Statesboro, GA
  • NPI 1437557287
  Medicare reassignment Care Compare group NPD
• Richard Tyler Cowart, MD

  • Surgery Physician
  • Statesboro, GA
  • NPI 1568862381
  Medicare reassignment Care Compare group NPD
• Anastasia Chefon Davis, FNP-BC

  • Family Nurse Practitioner
  • Statesboro, GA
  • NPI 1487197505
  Medicare reassignment Care Compare group NPD
• Brian Mixon Deloach, M.D.

  • Family Medicine Physician
  • Statesboro, GA
  • NPI 1841202868
  Medicare reassignment Care Compare group NPD
• Nicolle Maria Digerolamo-Thaller, APRN, BC

  • Adult Health Nurse Practitioner
  • Statesboro, GA
  • NPI 1881873099
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1260316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762214400000",
    "number": "1487983151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 MERIDIAN BLVD",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370676325",
            "telephone_number": "615-465-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1497 FAIR RD",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304580822",
            "telephone_number": "912-486-1710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST GEORGIA HMA PHYSICIAN MANAGEMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-09",
        "last_updated": "2025-11-04",
        "certification_date": "2025-11-04",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SR DIR PROV ENROLLMENT",
        "authorized_official_telephone_number": "615-465-7000"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• East Georgia Diagnostic Services
• East Georgia Foot and Ankle Center
• East Georgia Healthcare Center Inc (Statesboro Pediatrics & Family Healthcare)
• East Georgia Healthcare Center, Inc. (Langston Chapel Schools)
• East Georgia Healthcare Center, Inc. (Statesboro Pediatrics and Family Healthcare Center)
• East Georgia Medical Assoc. P C
• East Georgia Nephrology, PC
• East Georgia Oral & Maxillofacial Surgery Center
• East Georgia Orthopedic Center, PC.
• East Georgia Pediatrics

• Internal Medicine Physician in Statesboro, GA
• Providers in Statesboro, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.