Organization
EAST GEORGIA NEPHROLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES WILLIAM JACKSON JR. MD (OWNER)
(912) 871-2200
Entity
Organization
Contact information
Practice address
450 GEORGIA AVE, SUITE B, STATESBORO, GA 30458-5585
(912) 871-2200
(912) 871-2220
Mailing address
450 GEORGIA AVE, SUITE B, STATESBORO, GA 30458-5585
(912) 871-2200
(912) 871-2220
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
034372
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300034644A
—
GA
01
—
DN3298
RAILROAD MEDICARE
GA
Enumeration date
08/06/2007
Last updated
11/06/2015
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