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SOUTHEAST GEORGIA PEDIATRICS
NPI 1457613192
Clinic/Center - Primary Care in Waycross, GA

Active since June 08, 2012
1701 BOULEVARD SQ STE D, WAYCROSS, GA 31501(912) 387-0445(912) 226-3513 Get Directions Write a Review

NPPES record last updated: June 15, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Southeast Georgia Pediatrics NPPES

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

SOUTHEAST GEORGIA PEDIATRICS (NPI 1457613192) is a healthcare organization registered as a primary care in Waycross, Georgia and active in the NPI registry since June 2012. The organization lists Eugene Wynn Kallay, Owner, as its authorized official.

NPPES Registry Identity

NPI1457613192
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameSOUTHEAST GEORGIA PEDIATRICS
Location Address1701 BOULEVARD SQ STE DWaycross, GA 31501-8022
Mailing Address1701 Boulevard Sq Ste DWaycross, GA 31501-8022 · (912) 387-0445 · Fax (912) 226-3513
Phone(912) 387-0445
Fax(912) 226-3513
Organization SubpartNo
Authorized OfficialEugene Wynn KallayOwner · (478) 737-7653
Enumeration DateJune 8, 2012
Last NPPES UpdateJune 15, 2020
NPPES CertifiedJune 15, 2020
✔ NPI 1457613192 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
Licenses✔ Licensed in GA · 018950✔ Licensed in GA · 041044
1701 BOULEVARD SQ STE D, Waycross, GA 31501
Open in Google Maps ↗

Other Identifiers 2

Other1063595973Npi
Other1780767665Npi

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 11D2044019

Southeast Georgia Pediatrics, LLC · Waycross, GA
Expired · Aug 13, 2026
CLIA Number11D2044019
Laboratory TypePhysician Office
Certificate Effective DateAugust 14, 2024
Certificate Expiration DateAugust 13, 2026
Laboratory DirectorDr. Eugene Wynn Kallay
Laboratory Phone(912) 387-0445
Laboratory LocationSoutheast Georgia Pediatrics, LLC1701 D Boulevard Square, Waycross, GA 31501
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LINDSEY KAITLYN MORTON
Pediatrics
1701 BOULEVARD SQ STE D
WAYCROSS, GA 31501
Ware County (912) 387-0445
KERI TUTEN HALE NP
Nurse Practitioner (Pediatrics)
1701 BOULEVARD SQ STE D
WAYCROSS, GA 31501
Ware County (912) 387-0445
MRS. DANNETTE KALLAY M.D.
Pediatrics
1701 BOULEVARD SQ STE D
WAYCROSS, GA 31501
Ware County (912) 387-0445

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southeast Georgia Pediatrics's NPI number?

The NPI number for Southeast Georgia Pediatrics is 1457613192. It was assigned to this organization in the NPPES registry on June 8, 2012.

Where is Southeast Georgia Pediatrics located?

Southeast Georgia Pediatrics is located at 1701 Boulevard Sq Ste D, Waycross, GA 31501. The listed phone number is (912) 387-0445.

What is Southeast Georgia Pediatrics's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

When was this NPI record last updated?

The NPPES record for Southeast Georgia Pediatrics was last updated on June 15, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.