EAST GEORGIA NEPHROLOGY PC NPI 1215128186

NPI Information

  • NPI: 1215128186
  • Provider Name: EAST GEORGIA NEPHROLOGY, PC
  • Classification: Internal Medicine - 207RN0300X
  • Specialization: Nephrology
  • Entity Type: Organization
  • CLIA Number: 11D0997298
  • Address: 450 GEORGIA AVE
    SUITE B
    STATESBORO, GA
    ZIP 30458
  • Phone: (912) 871-2200

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NPI Details

EAST GEORGIA NEPHROLOGY, PC is a nephrology internal medicine in Statesboro, GA. The provider is an internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. EAST GEORGIA NEPHROLOGY, PC NPI is 1215128186. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

450 GEORGIA AVE
SUITE B
STATESBORO, GA
ZIP 30458-585
Phone: (912) 871-2200
Fax: (912) 871-2220

The provider's authorized official is James William Jackson .
The authorized official title is Owner and has the following contact phone number (912) 871-2200.

The CLIA number assigned to this NPI record is 11D0997298 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/6/2007 and was last updated on 11/6/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207RN0300XInternal MedicineNephrology034372GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1DN3298OTHERGEORGIARAILROAD MEDICARE
2300034644AMEDICAIDGEORGIA
3GRP4589MEDICARE PINGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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