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VIDALIA FAMILY HEALTH CLINIC LLC NPI 1205078979


NPI Information

NPI: 1205078979
Provider Name: VIDALIA FAMILY HEALTH CLINIC LLC

Doing Business As: SOUTHEAST REGIONAL PRIMAY CARE CORP

Classification: Specialist - 174400000X
Entity Type: Organization
Address:
1811 MANNING DR
VIDALIA, GA
ZIP 30474
Phone: (912) 537-7674
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VIDALIA FAMILY HEALTH CLINIC LLC is a specialist in Vidalia, GA. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. VIDALIA FAMILY HEALTH CLINIC LLC NPI is 1205078979. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Southeast Regional Primay Care Corp.

The provider's business location address is:

1811 MANNING DR
VIDALIA, GA
ZIP 30474-921
Phone: (912) 537-7674
Fax: (912) 538-8443

The provider's authorized official is Thomas Ferrari .
The authorized official title is Physician and has the following contact phone number (912) 537-7476.

The enumeration date for this NPI number is 3/27/2009 and was last updated on 3/27/2009.


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
1174400000XSpecialistGA034829GEORGIAYes

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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