Healthcare Provider Details

I. General information

NPI: 1871823302
Provider Name (Legal Business Name): SATILLA RHEUMATOLOGY AND INTERNAL MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615-A PENDLETON STREET
WAYCROSS GA
31501-4724
US

IV. Provider business mailing address

615-A PENDLETON STREET
WAYCROSS GA
31501-4724
US

V. Phone/Fax

Practice location:
  • Phone: 912-548-0710
  • Fax: 912-548-0071
Mailing address:
  • Phone: 912-548-0710
  • Fax: 912-548-0071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number055229
License Number StateGA

VIII. Authorized Official

Name: DR. CHARLES GALEA
Title or Position: OWNER
Credential: M.D.
Phone: 912-548-0710