Organization
EAST GEORGIA PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL DEAL MD (OWNER)
(912) 489-3325
Entity
Organization
Contact information
Practice address
715 NORTHSIDE DR E, SUITE 5 PMB 398, STATESBORO, GA 30458-4712
(912) 489-3325
(912) 764-4977
Mailing address
127 N COLLEGE ST, STATESBORO, GA 30458-5387
(912) 489-3325
(912) 764-4977
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000372391G
—
GA
01
—
10051619
AMERIGROUP
GA
01
—
354428
WELLCARE
GA
Enumeration date
07/14/2008
Last updated
07/14/2008
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