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NPI Code Detail

MEDICARE: SOUTHEAST GA PRIMARY PREVENT

MEDICARE: SOUTHEAST GA PRIMARY PREVENT
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
1207Q00000XFamily Medicine Physician052930GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1649470410
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHEAST GA PRIMARY PREVENT
Provider Business Mailing Address
First Line : 1811 EDWINA DR
Second Line :
City : VIDALIA
State : GA
Zip : 30474-8963
Country : US
Telephone Number : 912-537-9779
Fax Number : 912-537-2124
Provider Business Practice Location Address
First Line : 1811 EDWINA DR
Second Line :
City : VIDALIA
State : GA
Zip : 30474-8963
Country : US
Telephone Number : 912-537-9779
Fax Number : 912-537-2124
Authorized Official
Title or Position : BILLING MANAGER
Name : LISA W. BUSH
Credential :
Telephone Number : 912-537-9779
Provider Enumeration Date : 07/20/2007
Last Update Date : 05/08/2008

Similar Medicare Providers

1609874197 — ROBERT SCANLON DO
Practice Location Address:
1811 EDWINA DR
VIDALIA, GA
30474-8963
Practice Phone: 912-538-8105
Practice Fax: 912-538-8109
1366440984 — MARK HOERMAN MD
Practice Location Address:
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VIDALIA, GA
30474-8963
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1437145208 — DR. KURT PATRICK HOFMANN M.D.
Practice Location Address:
1811 EDWINA DR
VIDALIA, GA
30474-8963
Practice Phone: 912-538-9977
Practice Fax:
1780672287 — DR. GREGORY NORKUS M.D.
Practice Location Address:
1811 EDWINA DR
VIDALIA, GA
30474-8963
Practice Phone: 912-538-9977
Practice Fax:
1689789703 — NANCY ELWOOD, MD PC
Practice Location Address:
1811 EDWINA DR
VIDALIA, GA
30474-8963
Practice Phone: 912-538-9774
Practice Fax: 912-608-8037
1396944633 — SOUTHEASTERN CARDIOLOGY
Practice Location Address:
1811 EDWINA DR
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30474-8963
Practice Phone: 912-537-8988
Practice Fax: 912-608-8037

Directions to “SOUTHEAST GA PRIMARY PREVENT ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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