Healthcare Provider Details

I. General information

NPI: 1184697245
Provider Name (Legal Business Name): MEADOWS REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HARRIS INDUSTRIAL BLVD
VIDALIA GA
30474-8845
US

IV. Provider business mailing address

724 CHESLEY DR
VIDALIA GA
30474-5516
US

V. Phone/Fax

Practice location:
  • Phone: 912-277-2035
  • Fax: 912-277-2098
Mailing address:
  • Phone: 912-537-1590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT000250
License Number StateGA

VIII. Authorized Official

Name: NANCY W STANLEY
Title or Position: DIRECTOR OF REHAB
Credential:
Phone: 912-277-2034