Southeast Regional Primary Care Corporation

NPI #1063914851 in Vidalia, Georgia

Provider Information

NPI Number: 1063914851
Entity Type: Organization
Organization Name: Southeast Regional Primary Care Corporation
Primary Specialty: Internal Medicine
Enumeration Date: Mar 7, 2018
Last Updated: Dec 21, 2018

Practice Location

Address: 621 E 1ST ST STE B
City: Vidalia
State: Georgia
ZIP Code: 30474-4264
Phone: (912) 535-5120

Authorized Official

Name: TONY M O'STEEN
Title: CFO
Phone: (912) 535-5560

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X	Primary

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