# SOUTHERN MEDICAL ASSOCIATES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SOUTHEAST REGIONAL PRIMARY CARE CORPORATION
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1356764450
- **Legal business name:** SOUTHEAST REGIONAL PRIMARY CARE CORPORATION
- **Authorized official:** TONY M OSTEEN (CFO VP FINANCE)
- **Authorized official phone:** (912) 538-5314

## Contact information

- **Practice address:** 601 S VETERANS BLVD, GLENNVILLE, GA 30427-1775
- **Practice address phone:** (912) 654-0475
- **Practice address fax:** (912) 654-0486
- **Mailing address:** PO BOX 407, VIDALIA, GA 30475-0407
- **Mailing address phone:** (912) 537-4986

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 054519 | GA | Yes |

## Other

- **Enumeration date:** 01/24/2014
- **Last updated:** 09/04/2014