Organization
WAYNE SJC MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH P IERARDI (CEO)
(912) 427-7790
Entity
Organization
Contact information
Practice address
320 PEACHTREE ST, JESUP, GA 31545-0244
(912) 427-7790
(912) 427-7707
Mailing address
320 PEACHTREE ST, JESUP, GA 31545-0244
(912) 427-7790
(912) 427-7707
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
207Y00000X
Otolaryngology Physician
Primary
—
—
231H00000X
Audiologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003127436A
—
GA
05
—
272895969C
—
GA
Enumeration date
06/11/2012
Last updated
08/25/2016
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