Healthcare Provider Details

I. General information

NPI: 1063665834
Provider Name (Legal Business Name): SOUTH GEORGIA FAMILY MEDICINE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2008
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 BRAMPTON AVE
STATESBORO GA
30458-0850
US

IV. Provider business mailing address

1203 BRAMPTON AVE
STATESBORO GA
30458-0850
US

V. Phone/Fax

Practice location:
  • Phone: 912-871-7890
  • Fax: 912-871-7897
Mailing address:
  • Phone: 912-871-7890
  • Fax: 912-871-7897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number47085
License Number StateGA

VIII. Authorized Official

Name: DR. JOHN S GERGUIS
Title or Position: PRESIDENT
Credential: MD
Phone: 912-871-7890