# SOUTHEAST REGIONAL PRIMARY CARE CORPORATION

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

## Provider details

- **NPI number:** 1467568907
- **Authorized official:** TONY M OSTEEN (CFO)
- **Authorized official phone:** (912) 535-8691

## Contact information

- **Practice address:** ONE MEADOWS PARKWAY, VIDALIA, GA 30474-8921
- **Practice address phone:** (912) 535-3011
- **Practice address fax:** (912) 537-5366
- **Mailing address:** PO BOX 407, VIDALIA, GA 30475-0407
- **Mailing address phone:** (912) 535-3011
- **Mailing address fax:** (912) 538-5529

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | GA | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |
| 261QR0200X | Radiology Clinic/Center | — | NULL | — |
| 261QS1200X | Sleep Disorder Diagnostic Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 08/21/2006
- **Last updated:** 03/13/2019