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VIDALIA IMMEDIATE & PRIMARY CARE LLC
NPI 1942974167
Clinic/Center - Primary Care in Vidalia, GA

Active since August 02, 2021CLIA 11D2259716 · Waiver
122 ALICE COLEMAN DRIVE, VIDALIA, GA 30474(912) 805-2273 Get Directions Write a Review

NPPES record last updated: November 16, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Nov 16, 2021, Aug 3, 2021 (2 updates tracked since 2021).

About Vidalia Immediate & Primary Care Llc NPPES

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

VIDALIA IMMEDIATE & PRIMARY CARE LLC (NPI 1942974167) is a healthcare organization registered as a primary care in Vidalia, Georgia and active in the NPI registry since August 2021. The organization holds a CLIA Waiver certificate valid through May 9, 2028 and lists Melissa Ann Beckum, Practice Manager/office Manager, as its authorized official.

NPPES Registry Identity

NPI1942974167
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameVIDALIA IMMEDIATE & PRIMARY CARE LLC
Location Address122 ALICE COLEMAN DRIVEVidalia, GA 30474
Mailing AddressPo Box 2324Vidalia, GA 30475-2324 · (912) 805-2273
Phone(912) 805-2273
Organization SubpartNo
Authorized OfficialMelissa Ann BeckumPractice Manager/office Manager · (912) 293-2869
Enumeration DateAugust 2, 2021
Last NPPES UpdateNovember 16, 20212 updates tracked since enumeration
NPPES CertifiedNovember 16, 2021
✔ NPI 1942974167 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
122 ALICE COLEMAN DRIVE, Vidalia, GA 30474
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter Health, Ambetter of Alabama and more.Insurance ›

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 Waiver 11D2259716

Vidalia Immediate And Primary Care · Vidalia, GA
Active · expires May 9, 2028
CLIA Number11D2259716
Laboratory TypePhysician Office
Certificate Effective DateMay 10, 2026
Certificate Expiration DateMay 9, 2028
Laboratory DirectorDewey Howell
Laboratory Phone(912) 805-2273
Laboratory LocationVidalia Immediate And Primary Care122 Alice Coleman Drive, Vidalia, GA 30474
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

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.

DEWEY D HOWELL FNP-C
Nurse Practitioner (Family)
122 ALICE COLEMAN DRIVE
VIDALIA, GA 30474
Toombs County (912) 805-2273
AMANDA LARISCEY PA-C
Physician Assistant
122 ALICE COLEMAN DRIVE
VIDALIA, GA 30474
Toombs County (912) 805-2273
ALEXIS BYRD FOUNTAIN FNP-C
Nurse Practitioner (Family)
122 ALICE COLEMAN DRIVE
VIDALIA, GA 30474
Toombs County (912) 805-2273

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 Vidalia Immediate & Primary Care LLC's NPI number?

The NPI number for Vidalia Immediate & Primary Care LLC is 1942974167. It was assigned to this organization in the NPPES registry on August 2, 2021.

Where is Vidalia Immediate & Primary Care LLC located?

Vidalia Immediate & Primary Care LLC is located at 122 Alice Coleman Drive, Vidalia, GA 30474. The listed phone number is (912) 805-2273.

What is Vidalia Immediate & Primary Care LLC's specialty?

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

Does Vidalia Immediate & Primary Care LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2259716) is associated with this NPI, valid through May 9, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Vidalia Immediate & Primary Care LLC accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Vidalia Immediate & Primary Care LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Vidalia Immediate & Primary Care LLC was last updated on November 16, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.