Organization
STATESBORO ENT & FPS CLINIC, P.C.
Active
Other names
Statesboro ENT & H Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS M CREWS MD (OWNER)
(912) 764-8200
Entity
Organization
Contact information
Practice address
106 PROCTOR ST, STATESBORO, GA 30458-1351
(912) 764-8200
(912) 489-2954
Mailing address
106 PROCTOR ST, STATESBORO, GA 30458-1351
(912) 764-8200
(912) 489-2954
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
024663
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
REF761734385
MEDICAID REFERENCE #
GA
Enumeration date
05/26/2006
Last updated
01/05/2011
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