Provider Demographics
NPI:1184803215
Name:GEERDES, JOHN DOUGLAS (D'MIN/LMFT)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DOUGLAS
Last Name:GEERDES
Suffix:
Gender:M
Credentials:D'MIN/LMFT
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:D
Other - Last Name:GEERDES
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:D'MIN/LMFT
Mailing Address - Street 1:19 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-5385
Mailing Address - Country:US
Mailing Address - Phone:912-489-7590
Mailing Address - Fax:912-489-7590
Practice Address - Street 1:19 CHURCH ST
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5385
Practice Address - Country:US
Practice Address - Phone:912-489-7590
Practice Address - Fax:912-489-7590
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT000892106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA348418841AMedicaid
GA01359450OtherAMERIGROUP
GA690643OtherWELLCARE