Provider Demographics
NPI:1528104510
Name:BONE AND JOINT INSTITUTE OF SOUTH GEORGIA, P.C.
Entity type:Organization
Organization Name:BONE AND JOINT INSTITUTE OF SOUTH GEORGIA, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:VALOSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-427-0800
Mailing Address - Street 1:PO BOX 1334
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31598-1334
Mailing Address - Country:US
Mailing Address - Phone:912-427-0800
Mailing Address - Fax:912-810-5556
Practice Address - Street 1:110 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0044
Practice Address - Country:US
Practice Address - Phone:912-427-0800
Practice Address - Fax:912-427-6029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030633207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003151448BMedicaid
GA003151448CMedicaid
GA003152097DMedicaid
GA100002585AMedicaid
GA003134292KMedicaid
GA100002585CMedicaid
GA100002585DMedicaid
GA002374132DMedicaid
GA1648245OtherAMERIGROUP
GA692353788BMedicaid
GA002374132BMedicaid
GA003152097CMedicaid
GA003274130BMedicaid
GA003274130CMedicaid
GA002374132AMedicaid
GA002374132CMedicaid
GA003134292JMedicaid
GA003274130AGMedicaid
GA676978OtherWELLCARE
GA692353788CMedicaid
GA003274130DMedicaid
GA100002585EMedicaid
GA692353788DMedicaid
GA692353788EMedicaid