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: July 19, 2026.

  • Organization
  • Family Medicine

About SOUTHEAST GA PRIMARY PREVENT

This page provides the complete NPI Profile along with additional information for Southeast Ga Primary Prevent, a primary care provider established in Vidalia, Georgia operating as a Family Medicine. The healthcare provider is registered in the NPI registry with number 1649470410 assigned on July 2007. The practitioner's primary taxonomy code is 207Q00000X with license number 052930 (GA). The provider is registered as an organization and their NPI record was last updated 18 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The authorized official of this NPI record is Lisa W. Bush (Billing Manager)

NPI
1649470410 Verify this NPI
Provider Name
SOUTHEAST GA PRIMARY PREVENT
Entity Type
Organization
Location Address
1811 EDWINA DR VIDALIA, GA 30474
Location Phone
(912) 537-9779
Location Fax
(912) 537-2124
Mailing Address
1811 EDWINA DR VIDALIA, GA 30474
Mailing Phone
(912) 537-9779
Mailing Fax
(912) 537-2124
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
07-20-2007
Last Update Date
05-08-2008
Code Navigator

A primary care provider (PCP) like Southeast Ga Primary Prevent sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc .

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Family Medicine

Taxonomy Code
207Q00000X
Type
Allopathic & Osteopathic Physicians
License No.
052930
License State
GA
Taxonomy Description
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.

Group Taxonomy 193400000X SINGLE SPECIALTY GROUP

This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

LISA W. BUSH

Authorized Official Title
BILLING MANAGER
Authorized Official Phone
(912) 537-9779

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State Identifier Issuer
DA8045MEDICARE PIN (08)GA 
000978128IMEDICAID (05)GA 
GRP5189MEDICARE PIN (08)GA 
H52717MEDICARE UPIN (02)GA 

Reviews for SOUTHEAST GA PRIMARY PREVENT

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Other Providers at the Same Location


The following 14 providers are registered at the same or a nearby location.

Family Medicine
1811 EDWINA DR
VIDALIA, GA 30474
Internal Medicine (Cardiovascular Disease)
1811 EDWINA DR
VIDALIA, GA 30474
Internal Medicine (Pulmonary Disease)
1811 EDWINA DR
VIDALIA, GA 30474
Family Medicine
1811 EDWINA DR
VIDALIA, GA 30474
Internal Medicine (Pulmonary Disease)
1811 EDWINA DR
VIDALIA, GA 30474
Surgery
1811 EDWINA DR
VIDALIA, GA 30474
Surgery
1811 EDWINA DR
VIDALIA, GA 30474
Surgery
1811 EDWINA DR
VIDALIA, GA 30474
Internal Medicine (Pulmonary Disease)
1811 EDWINA DR
VIDALIA, GA 30474
Surgery
1811 EDWINA DR
VIDALIA, GA 30474
Specialist
1811 EDWINA DR
VIDALIA, GA 30474
Surgery
1811 EDWINA DR
VIDALIA, GA 30474
Internal Medicine (Pulmonary Disease)
1811 EDWINA DR
VIDALIA, GA 30474
Nurse Practitioner (Family)
1811 EDWINA DR
VIDALIA, GA 30474

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1649470410, enumerated as an "organization" on July 20, 2007.

The provider is located at 1811 EDWINA DR VIDALIA, GA 30474 and the phone number is (912) 537-9779.

Family Medicine with taxonomy code 207Q00000X.

The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.