Healthcare Provider Details

I. General information

NPI: 1457245987
Provider Name (Legal Business Name): JOEL PADGETT RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1332 SOUTHERN DR
STATESBORO GA
30460-1360
US

IV. Provider business mailing address

1332 SOUTHERN DR
STATESBORO GA
30460-1360
US

V. Phone/Fax

Practice location:
  • Phone: 912-478-4636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN280493
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN280493
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: