Organization
STATESBORO MEDICAL GROUP, LLC
Active
Other names
Statesboro urgent care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SREEVALLI DEGA MD (OWNER)
(912) 259-9474
Entity
Organization
Contact information
Practice address
1176 BRAMPTON AVE, STATESBORO, GA 30458-0847
(912) 259-9474
Mailing address
106 IRONGATE PL, STATESBORO, GA 30458-9173
(912) 531-7338
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1023247723
NPI
GA
01
—
1023247731
NPI
GA
Enumeration date
07/09/2020
Last updated
09/11/2020
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