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SOUTH GEORGIA PEDIATRICS P.C. NPI 1578797627


NPI Information

NPI: 1578797627
Provider Name: SOUTH GEORGIA PEDIATRICS, P.C.
Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 11D1099601

Address:
1230 BRAMPTON AVE
STATESBORO, GA
ZIP 30458
Phone: (912) 489-5437
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SOUTH GEORGIA PEDIATRICS, P.C. is a specialist in Statesboro, GA. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. SOUTH GEORGIA PEDIATRICS, P.C. NPI is 1578797627. The provider is registered as an organization entity type.

The provider's business location address is:

1230 BRAMPTON AVE
STATESBORO, GA
ZIP 30458-849
Phone: (912) 489-5437
Fax: (912) 489-5550

The provider's authorized official is Rao Tulasi Immaneni .
The authorized official title is Ceo and has the following contact phone number (912) 247-0409.

The CLIA number assigned to this NPI record is 11D1099601 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/5/2009 and was last updated on 5/7/2009.


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
1261Q00000XClinic/CenterAPPLIED FORGEORGIANo
2174400000XSpecialist044756GEORGIAYes

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

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.