STATESBORO CARDIOLOGY, PC – Cardiovascular Disease Physician, NPI 1205840105
Cardiovascular Disease Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for STATESBORO CARDIOLOGY, PC
131 Memorial Dr
Reidsville, GA 304534641
Phone: (912) 489-6246
Fax: (912) 489-6346
Type: Location
125C Victory Dr
Swainsboro, GA 304013234
Phone: (912) 489-6246
Fax: (912) 489-6346
Type: Location
400 Cedar St Ste 107
Metter, GA 304393338
Phone: (912) 489-6246
Fax: (912) 489-6346
Type: Location
380 Sconyers St
Metter, GA 304393261
Phone: (912) 489-6246
Fax: (912) 489-6346
Type: Location
Grady Johnson Road, Somerset, Statesboro, Bulloch County, Georgia, 30460, United States
STATESBORO, GA 304586026
Phone: (912) 489-6843
Fax: (912) 489-3125
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
Loading prescription activity...
Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-10-01
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20041001000834 | O | Clinic/Group Practice | GA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 30453)
Loading plans...
Reviews
All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.
No reviews yet. Be the first to share your experience — your opinion helps families compare providers.