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General NPI Number Information
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NPI Number | 1427126614
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Entity Type | Organization
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Legal Business Name | SOUTHEAST GERIATRICS INC
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 160 SPRING BRANCH DR
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City | DUBLIN
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State | GA
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Zip | 31021-0356
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Country | US
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Telephone | 478-274-0269
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Fax | 888-326-5817
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Provider Business Mailing Address
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Address Line | 160 SPRING BRANCH DR
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City | DUBLIN
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State | GA
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Zip | 31021-0356
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Country | US
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Telephone | 478-274-0269
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Fax | 888-326-5817
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Authorized Official
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Title or Position | PHYSICIAN
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Name | WILLIAM DENNIS TAYLOR
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Credential | M.D.
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Telephone | 478-285-4022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 033213
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License Number State | GA
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