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NPI Code Detail

MEDICARE: SOUTHEASTERN CARDIOVASCULAR IMG, INC.

MEDICARE: SOUTHEASTERN CARDIOVASCULAR IMG, INC.
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
1207R00000XInternal Medicine Physician028618GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528264629
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHEASTERN CARDIOVASCULAR IMG, INC.
Provider Business Mailing Address
First Line : 1006A MOUNT VERNON RD
Second Line :
City : VIDALIA
State : GA
Zip : 30474-3029
Country : US
Telephone Number : 912-537-9826
Fax Number : 912-537-2182
Provider Business Practice Location Address
First Line : 1006A MOUNT VERNON RD
Second Line :
City : VIDALIA
State : GA
Zip : 30474-3029
Country : US
Telephone Number : 912-537-9826
Fax Number : 912-537-2182
Authorized Official
Title or Position : MD
Name : DR. DAVID H PAINE
Credential : MD
Telephone Number : 912-537-9826
Provider Enumeration Date : 06/25/2007
Last Update Date : 01/05/2010

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Directions to “SOUTHEASTERN CARDIOVASCULAR IMG, INC. ” Practice Location

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