Healthcare Provider Details

I. General information

NPI: 1245135540
Provider Name (Legal Business Name): EAST GEORGIA REGIONAL MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 COACH LEE HILL BLVD
STATESBORO GA
30458-4786
US

IV. Provider business mailing address

1499 FAIR RD
STATESBORO GA
30458-1683
US

V. Phone/Fax

Practice location:
  • Phone: 912-764-5656
  • Fax: 912-871-2354
Mailing address:
  • Phone: 912-786-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: PAULA LALOR
Title or Position: SENIOR DIRECTOR
Credential:
Phone: 629-215-3953