NPI 1063914851

Southeast Regional Primary Care Corporation

Organisation Internal Medicine Physician Vidalia, GA

Practice location

Address: 621 E 1st St STE B, Vidalia, GA 30474-4264
Phone: (912) 535-5120
Mailing address: PO Box 407, Vidalia, GA 30475-0407

Authorised official

Name: Tony M O'Steen
Title: Cfo
Phone: (912) 535-5560

Registered specialties

Internal Medicine Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207R00000X

Other Internal Medicine providers in Georgia →

Registry record

NPI: 1063914851
Entity type: Organization
NPI issued: 7 Mar 2018
Record last updated: 21 Dec 2018

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.