Provider Demographics
NPI:1336197250
Name:GERGUIS, JOHN S (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:GERGUIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1203 BRAMPTON AVE STE 102
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
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA047085207Q00000X
GA47085207QH0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00834919AMedicaid
GA00834919AMedicaid
GA08BDQBFMedicare ID - Type Unspecified
511I080686Medicare PIN