Vidalia Children's Center LLC

NPI #1679705115 in Vidalia, Georgia

Provider Information

NPI Number: 1679705115
Entity Type: Organization
Organization Name: Vidalia Children's Center LLC
Subpart: Yes (part of a larger organization)
Parent Organization: SOUTHEADT REGIONAL PRIMARY CARE CORPORATION
Primary Specialty: Pediatrics
Enumeration Date: Aug 18, 2009
Last Updated: Sep 5, 2014

Practice Location

Address: 125 CHURCH STREET
City: Vidalia
State: Georgia
ZIP Code: 30474
Phone: (912) 538-8484

Authorized Official

Name: TONY M OSTEEN, CFO
Title: CFO
Phone: (912) 538-5314

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pediatrics	208000000X	Primary

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