Statesboro Neurosurgery, LLC

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

057629 Issued in GA

Legal business name

STATESBORO NEUROSURGERY, LLC

Practice address

1211 Merchant Way Ste 401
Statesboro, GA 30458-0867

Phone

(912) 871-7777

Fax

(912) 871-7172

NPI assigned

Oct 15, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Donald V Graham, D.O.NPI 1639287949

Title

Neurosurgeon

Phone

(912) 871-7777

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

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

• Donald Graham, D.O.

  • Specialist
  • Statesboro, GA
  • NPI 1639287949

  GA

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1224028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224028800000",
    "number": "1497907935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 MERCHANT WAY STE 401",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304580867",
            "telephone_number": "912-871-7777",
            "fax_number": "912-871-7172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 MERCHANT WAY STE 401",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304580867",
            "telephone_number": "912-871-7777",
            "fax_number": "912-871-7172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATESBORO NEUROSURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-15",
        "last_updated": "2008-10-15",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "NEUROSURGEON",
        "authorized_official_telephone_number": "912-871-7777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": "GA",
            "license": "057629",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "897954893A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Statesboro Hma Medical Group, LLC
• Statesboro Hma Physician Management LLC
• Statesboro Imaging Center, P.C.
• Statesboro Imaging Center, P.C.
• Statesboro Medical Group, LLC
• Statesboro OB-GYN Specialists, PC
• Statesboro Oncology Assoc.
• Statesboro Opco LLC
• Statesboro Oral and Maxillofacial Surgery, Inc.
• Statesboro Pathology Associates

• All providers in Statesboro, GA
• Neurological Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2008; 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.