SOUTHEAST REGIONAL PRIMAY CARE CORP - NPI 1205078979

Q: What is the provider's specialty?

The provider's specialty is Specialist with taxonomy code 174400000X.

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About Southeast Regional Primay Care Corp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHEAST REGIONAL PRIMAY CARE CORP (NPI 1205078979) is a healthcare organization registered as a specialist in Vidalia, Georgia and active in the NPI registry since March 2009. The organization lists Thomas Ferrari, Physician, as its authorized official.

NPPES Registry Identity

NPI1205078979

Entity TypeOrganization

Primary Taxonomy174400000X

Legal Business NameVIDALIA FAMILY HEALTH CLINIC LLC

Location Address1811 MANNING DRVidalia, GA 30474-8921

Mailing Address1811 Manning DrVidalia, GA 30474-8921 · (912) 537-7674 · Fax (912) 538-8443

Phone(912) 537-7674

Fax(912) 538-8443

Organization SubpartNo

Authorized OfficialThomas FerrariPhysician · (912) 537-7476

Enumeration DateMarch 27, 2009

✔ NPI 1205078979 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers

Taxonomy Code174400000X

License✔ Licensed in GA · GA034829

Definition

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.

1811 MANNING DR, Vidalia, GA 30474

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Other Names 1

Doing Business AsSoutheast Regional Primay Care Corp

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP