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NPI Code Detail

MEDICARE: SOUTHEASTERN CARDIOLOGY

MEDICARE: SOUTHEASTERN CARDIOLOGY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RC0000XCardiovascular Disease Physician53388GA

General Provider Information

NPI Number : 1396944633
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHEASTERN CARDIOLOGY
Provider Business Mailing Address
First Line : 1811 EDWINA DR
Second Line :
City : VIDALIA
State : GA
Zip : 30474-8963
Country : US
Telephone Number : 912-537-8988
Fax Number : 912-608-8037
Provider Business Practice Location Address
First Line : 1811 EDWINA DR
Second Line :
City : VIDALIA
State : GA
Zip : 30474-8963
Country : US
Telephone Number : 912-537-8988
Fax Number : 912-608-8037
Authorized Official
Title or Position : PRACTICE MANAGER
Name : MRS. DEBORAH GRACE ELLIOTT-SMITH
Credential : RN
Telephone Number : 912-537-8988
Provider Enumeration Date : 07/17/2007
Last Update Date : 07/17/2007

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Directions to “SOUTHEASTERN CARDIOLOGY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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