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WAYNE SJC MEDICAL GROUP LLC NPI 1538421177


NPI Information

NPI: 1538421177
Provider Name: WAYNE SJC MEDICAL GROUP, LLC
Classification: Otolaryngology - 207Y00000X
Entity Type: Organization

CLIA Number: 11D2214854

Address:
320 PEACHTREE ST
JESUP, GA
ZIP 31545
Phone: (912) 427-7790
Get Directions

WAYNE SJC MEDICAL GROUP, LLC is an otolaryngology in Jesup, GA. The provider is an otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise. WAYNE SJC MEDICAL GROUP, LLC NPI is 1538421177. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

320 PEACHTREE ST
JESUP, GA
ZIP 31545-244
Phone: (912) 427-7790
Fax: (912) 427-7707

The provider's authorized official is Joseph P Ierardi .
The authorized official title is Ceo and has the following contact phone number (912) 427-7790.

The CLIA number assigned to this NPI record is 11D2214854 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 6/11/2012 and was last updated on 8/25/2016.


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
1207RC0200XInternal MedicineCritical Care MedicineNo
2207RC0000XInternal MedicineCardiovascular DiseaseNo
3207Q00000XFamily MedicineNo
4231H00000XAudiologistNo
5207Y00000XOtolaryngologyYes
6207X00000XOrthopaedic SurgeryNo

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
1272895969CMEDICAIDGEORGIA
2003127436AMEDICAIDGEORGIA
3202G707585MEDICARE UPINGEORGIA

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: 5/5/2024

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