Organization
ODELL STILL DO LLC
Active
Parent organization
SOUTHEAST REGIONAL PRIMARY CARE CORPORATION
Other names
Southeast Regional Primary Care Corp
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHEAST REGIONAL PRIMARY CARE CORPORATION
Authorized official
TONY M OSTEEN (CFO)
(912) 538-5314
Entity
Organization
Contact information
Practice address
28 W RAILROAD AVE, ALAMO, GA 30411-3513
(912) 568-1407
(912) 568-1579
Mailing address
PO BOX 407, VIDALIA, GA 30475-0407
(912) 537-4986
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
08/30/2010
Last updated
09/15/2015
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