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

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

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John Michael Allen, M.D.

  • Surgery Physician
  • Lagrange, GA
  • NPI 1912142720

  GA, Surgery

  Medicare reassignment Care Compare group NPD
• Tarek Amoun, MD

  • Pulmonary Disease Physician
  • Statesboro, GA
  • NPI 1487176327

  GA, Pulmonary Disease

  Medicare reassignment Care Compare group NPD
• Rosa M Austin, FNP

  • Family Nurse Practitioner
  • Statesboro, GA
  • NPI 1831491091

  GA

  Medicare reassignment Care Compare group NPD
• Basil Sohail Bangash

  • Pulmonary Disease Physician
  • Statesboro, GA
  • NPI 1144750571

  GA, Internal Medicine

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

  • Family Medicine Physician
  • Statesboro, GA
  • NPI 1013921428

  Family Medicine, GA

  Medicare reassignment Care Compare group NPD
• Carla S. Branch, M.D.

  • Family Medicine Physician
  • Statesboro, GA
  • NPI 1851394969

  Family Medicine, GA

  Medicare reassignment Care Compare group NPD
• Andrew Vincent Cichelli, MD

  • Pulmonary Disease Physician
  • Statesboro, GA
  • NPI 1710044557

  GA, Pulmonary Disease

  Medicare reassignment Care Compare group NPD
• Shelly Clary, FNP-BC

  • Family Nurse Practitioner
  • Statesboro, GA
  • NPI 1437557287

  GA

  Medicare reassignment Care Compare group NPD
• Richard Tyler Cowart, MD

  • Surgery Physician
  • Statesboro, GA
  • NPI 1568862381

  GA, Surgery

  Medicare reassignment Care Compare group NPD
• Anastasia Chefon Davis, FNP-BC

  • Family Nurse Practitioner
  • Statesboro, GA
  • NPI 1487197505

  GA

  Medicare reassignment Care Compare group NPD
• Brian Mixon Deloach, M.D.

  • Family Medicine Physician
  • Statesboro, GA
  • NPI 1841202868

  Family Medicine, GA

  Medicare reassignment Care Compare group NPD
• Nicolle Maria Digerolamo-Thaller, APRN, BC

  • Adult Health Nurse Practitioner
  • Statesboro, GA
  • NPI 1881873099

  GA

  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
• East Georgia Healthcare Center, Inc.
• East Georgia Healthcare Center, Inc.
• East Georgia Medical Assoc. P C
• East Georgia Nephrology, PC
• East Georgia Oral & Maxillofacial Surgery Center
• East Georgia Orthopedic Center, PC.
• East Georgia Pediatrics

• All providers in Statesboro, GA
• 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.