# SOUTHEAST GEORGIA PRIMARY CARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053429688
- **Authorized official:** DR. MATTHEW G PROHASKA D.O. (DOCTOR)
- **Authorized official phone:** (912) 283-1359

## Contact information

- **Practice address:** 409 UVALDA ST, WAYCROSS, GA 31501-4574
- **Practice address phone:** (912) 283-1359
- **Practice address fax:** (912) 283-1362
- **Mailing address:** 409 UVALDA ST, WAYCROSS, GA 31501-4574
- **Mailing address phone:** (912) 283-1359
- **Mailing address fax:** (912) 283-1362

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/25/2006
- **Last updated:** 08/22/2020