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General NPI Number Information
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NPI Number | 1528264629
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN CARDIOVASCULAR IMG, INC.
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 01/05/2010
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Provider Practice Location Address
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Address Line | 1006A MOUNT VERNON RD
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City | VIDALIA
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State | GA
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Zip | 30474-3029
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Country | US
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Telephone | 912-537-9826
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Fax | 912-537-2182
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Provider Business Mailing Address
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Address Line | 1006A MOUNT VERNON RD
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City | VIDALIA
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State | GA
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Zip | 30474-3029
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Country | US
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Telephone | 912-537-9826
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Fax | 912-537-2182
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Authorized Official
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Title or Position | MD
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Name | DR. DAVID H PAINE
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Credential | MD
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Telephone | 912-537-9826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 028618
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License Number State | GA
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