# SMITH & PURVIS FAMILY PRACTICE CLINIC, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Statesboro Family Practice Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043384183
- **Authorized official:** MS. TERI S DAIGNEAULT CPC (MEDICAL CODER)
- **Authorized official phone:** (912) 764-1039

## Contact information

- **Practice address:** 412 NORTHSIDE DR E, SUITE 200, STATESBORO, GA 30458-4802
- **Practice address phone:** (912) 764-9684
- **Practice address fax:** (912) 489-8676
- **Mailing address:** 412 NORTHSIDE DR E, SUITE 200, STATESBORO, GA 30458-4802
- **Mailing address phone:** (912) 764-9684
- **Mailing address fax:** (912) 489-8676

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 029847 | GA | — |
| 207Q00000X | Family Medicine Physician | 048703 | GA | — |
| 207Q00000X | Family Medicine Physician | 18745 | GA | Yes |

## Other

- **Enumeration date:** 11/20/2006
- **Last updated:** 08/22/2020