Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 047085 | GA |
Y | 207Q00000X | Family Doctor | 47085 | GA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 47085 | GA |
NPI | 1336197250 |
---|---|
Provider Name | Dr. John S Gerguis |
First Address | Statesboro, GA 30458-0850 |
Second Address | Statesboro, GA 30458-0850 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 07/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00834919A | (05) | GA |
G63467 | (02) | GA |