Provider Demographics
NPI:1558428326
Name:SEGERBERG, ERIC C (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:C
Last Name:SEGERBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 STARLING STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4267
Mailing Address - Country:US
Mailing Address - Phone:912-265-5125
Mailing Address - Fax:912-261-0907
Practice Address - Street 1:2500 STARLING STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4267
Practice Address - Country:US
Practice Address - Phone:912-265-5125
Practice Address - Fax:912-261-0907
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA19600208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00180991AMedicaid
GA00180991AMedicaid