Organization
STATESBORO HMA PHYSICIAN MANAGEMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L JACKSON (SR DUR PROV ENROLLMENT)
(615) 465-7000
Entity
Organization
Contact information
Practice address
1499 FAIR RD, STATESBORO, GA 30458-1683
(912) 871-5437
(912) 871-8595
Mailing address
4000 MERIDIAN BLVD, FRANKLIN, TN 37067-6325
(615) 465-7000
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
—
—
363LA2100X
Acute Care Nurse Practitioner
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP 366354327A
—
GA
Enumeration date
01/13/2007
Last updated
12/13/2022
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