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General NPI Number Information
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NPI Number | 1174154421
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN UROGYNECOLOGY & PELVIC SURGERY LLC
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Dates
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Enumeration Date | 01/27/2020
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 115 31ST AVE SE
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City | MOULTRIE
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State | GA
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Zip | 31768-6771
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Country | US
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Telephone | 229-502-9788
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Fax | 229-890-1266
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Provider Business Mailing Address
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Address Line | PO BOX 2876
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City | MOULTRIE
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State | GA
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Zip | 31776-2876
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Country | US
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Telephone | 229-502-9788
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Fax | 229-217-4910
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Authorized Official
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Title or Position | CEO
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Name | JAMES L MATNEY
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Credential |
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Telephone | 229-985-3420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VF0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
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License Number |
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License Number State |
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