SOUTHEAST GA PRIMARY PREVENT

VIDALIA, GA
NPI1649470410
Entity TypeOrganization
Authorized ContactLISA W. BUSH
Billing Manager
912-537-9779
Organization Subpart ?No
Primary Taxonomy207Q00000X Family Medicine
(Licence: GA  052930)
Enumeration Date2007-07-20
Last Update Date2008-05-08
Business Address
SOUTHEAST GA PRIMARY PREVENT
1811 EDWINA DR
VIDALIA, GA 30474-8963
Phone number: 912-537-9779
Mailing Address
SOUTHEAST GA PRIMARY PREVENT
1811 EDWINA DR
VIDALIA, GA 30474-8963
Phone number: 912-537-9779