Southeast Ga Primary Prevent

NPI #1649470410 in Vidalia, Georgia

Provider Information

NPI Number
1649470410
Entity Type
Organization
Organization Name
Southeast Ga Primary Prevent
Primary Specialty
Family Medicine
Enumeration Date
Jul 20, 2007
Last Updated
May 8, 2008

Practice Location

Address
1811 EDWINA DR
State
Georgia
ZIP Code
30474-8963
Phone
(912) 537-9779

Authorized Official

Name
LISA W. BUSH
Title
BILLING MANAGER
Phone
(912) 537-9779

Specialties & Taxonomy Codes

Specialty
Family Medicine

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Part of Southeast Regional Primary Care Corporation

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