Provider Demographics
NPI:1063665834
Name:SOUTH GEORGIA FAMILY MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:SOUTH GEORGIA FAMILY MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SABRI
Authorized Official - Last Name:GERGUIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-871-7890
Mailing Address - Street 1:1203 BRAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0850
Mailing Address - Country:US
Mailing Address - Phone:912-871-7890
Mailing Address - Fax:912-871-7897
Practice Address - Street 1:1203 BRAMPTON AVE
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0850
Practice Address - Country:US
Practice Address - Phone:912-871-7890
Practice Address - Fax:912-871-7897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-24
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA47085207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1063665834Medicaid