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SOUTHEAST GA PRIMARY PREVENT
NPI 1649470410
Family Medicine in Vidalia, GA

Active since July 20, 2007
1811 EDWINA DR, VIDALIA, GA 30474(912) 537-9779(912) 537-2124 Get Directions Write a Review

NPPES record last updated: May 8, 2008. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Southeast Ga Primary Prevent NPPES

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

SOUTHEAST GA PRIMARY PREVENT (NPI 1649470410) is a healthcare organization registered as a family medicine in Vidalia, Georgia and active in the NPI registry since July 2007. The organization lists Lisa W. Bush, Billing Manager, as its authorized official.

NPPES Registry Identity

NPI1649470410
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameSOUTHEAST GA PRIMARY PREVENT
Location Address1811 EDWINA DRVidalia, GA 30474-8963
Mailing Address1811 Edwina DrVidalia, GA 30474-8963 · (912) 537-9779 · Fax (912) 537-2124
Phone(912) 537-9779
Fax(912) 537-2124
Organization SubpartNo
Authorized OfficialLisa W. BushBilling Manager · (912) 537-9779
Enumeration DateJuly 20, 2007
Last NPPES UpdateMay 8, 2008
✔ NPI 1649470410 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in GA · 052930
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
1811 EDWINA DR, Vidalia, GA 30474
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Other Identifiers 4

Medicare PINDA8045GA
Medicaid000978128IGA
Medicare PINGRP5189GA
Medicare UPINH52717GA

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 15

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

VIDALIA SURGICAL ASSOCIATES, LLC
Specialist
1811 EDWINA DR
VIDALIA, GA 30474
Toombs County (912) 538-9977
VIDALIA PULMONOLOGY CENTER, LLC
Internal Medicine (Pulmonary Disease)
1811 EDWINA DR
VIDALIA, GA 30474
Toombs County (912) 538-8105
SOUTHEAST REGIONAL PRIMARY CARE CORPORATION
Internal Medicine (Pulmonary Disease)
1811 EDWINA DR
VIDALIA, GA 30474
Toombs County (912) 538-8105
JOSEPH G FOUST MD LLC
Family Medicine
1811 EDWINA DR
VIDALIA, GA 30474
Toombs County (912) 537-9779
MARK HOERMAN MD
Internal Medicine (Pulmonary Disease)
1811 EDWINA DR
VIDALIA, GA 30474
Toombs County (912) 538-8105
SOUTHEASTERN CARDIOLOGY
Internal Medicine (Cardiovascular Disease)
1811 EDWINA DR
VIDALIA, GA 30474
Toombs County (912) 537-8988
DR. KURT PATRICK HOFMANN M.D.
Surgery
1811 EDWINA DR
VIDALIA, GA 30474
Toombs County (912) 538-9977
ASHLEY NASWORTHY
Nurse Practitioner (Family)
1811 EDWINA DR
VIDALIA, GA 30474
Toombs County (912) 538-8105

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 Ga Primary Prevent's NPI number?

The NPI number for Southeast Ga Primary Prevent is 1649470410. It was assigned to this organization in the NPPES registry on July 20, 2007.

Where is Southeast Ga Primary Prevent located?

Southeast Ga Primary Prevent is located at 1811 Edwina Dr, Vidalia, GA 30474. The listed phone number is (912) 537-9779.

What is Southeast Ga Primary Prevent's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

When was this NPI record last updated?

The NPPES record for Southeast Ga Primary Prevent was last updated on May 8, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.