Provider Demographics
NPI:1003011693
Name:EAST GEORGIA URGENT CARE
Entity Type:Organization
Organization Name:EAST GEORGIA URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:912-764-2273
Mailing Address - Street 1:PO BOX 1989
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-1989
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4451 COUNTRY CLUB RD
Practice Address - Street 2:SUITE 3A
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30459
Practice Address - Country:US
Practice Address - Phone:912-764-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7310Medicare ID - Type Unspecified