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SOUTHEASTERN UROGYNECOLOGY AND PELVIC SURGERY LLC NPI 1174154421


NPI Information

NPI: 1174154421
Provider Name: SOUTHEASTERN UROGYNECOLOGY AND PELVIC SURGERY LLC
Classification: Obstetrics & Gynecology - 207VF0040X
Entity Type: Organization

Specialization: Female Pelvic Medicine and Reconstructive Surgery

CLIA Number: 11D2199857

Address:
115 31ST AVE SE
MOULTRIE, GA
ZIP 31768
Phone: (229) 502-9788
Get Directions

SOUTHEASTERN UROGYNECOLOGY AND PELVIC SURGERY LLC is a female pelvic medicine and reconstructive surgery obstetrics gynecology in Moultrie, GA. The provider is an obstetrics & gynecology physician subspecialist in Female Pelvic Medicine and Reconstructive Surgery is a physician in Urology or Obstetrics and Gynecology who, by virtue of education and training, is prepared to provide consultation and comprehensive management of women with complex benign pelvic conditions, lower urinary tract disorders, and pelvic floor dysfunction. Comprehensive management includes those diagnostic and therapeutic procedures necessary for the total care of the patient with these conditions and complications resulting from them. SOUTHEASTERN UROGYNECOLOGY AND PELVIC SURGERY LLC NPI is 1174154421. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

115 31ST AVE SE
MOULTRIE, GA
ZIP 31768-771
Phone: (229) 502-9788
Fax: (229) 890-1266

The provider's authorized official is Debbie Renee Herring .
The authorized official title is Practice Adminstrator and has the following contact phone number (229) 502-9788.

The CLIA number assigned to this NPI record is 11D2199857 - physician office with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 1/27/2020 and was last updated on 11/7/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207VF0040XObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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