MEDICARE: SOUTHEAST GERIATRICS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	313M00000X	Nursing Facility/Intermediate Care Facility	033213	GA

General Provider Information

NPI Number	:	1427126614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST GERIATRICS INC

Provider Business Mailing Address
First Line	:	160 SPRING BRANCH DR
Second Line	:
City	:	DUBLIN
State	:	GA
Zip	:	31021-0356
Country	:	US
Telephone Number	:	478-274-0269
Fax Number	:	888-326-5817

Provider Business Practice Location Address
First Line	:	160 SPRING BRANCH DR
Second Line	:
City	:	DUBLIN
State	:	GA
Zip	:	31021-0356
Country	:	US
Telephone Number	:	478-274-0269
Fax Number	:	888-326-5817

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	WILLIAM DENNIS TAYLOR
Credential	:	M.D.
Telephone Number	:	478-285-4022

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	08/22/2020

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