Organization
SOUTHEAST INTERNAL MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAULINE M BELLECCI MD (PHYSICIAN)
(912) 287-1555
Entity
Organization
Contact information
Practice address
406 RIVERSIDE DR, WAYCROSS, GA 31501-5315
(912) 287-1555
Mailing address
PO BOX 777, WAYCROSS, GA 31502-0777
(912) 287-1555
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CC4999
PALMETTO GBA MEDICARE
GA
01
—
GRP642
MEDICARE PTAN
GA
Enumeration date
07/21/2006
Last updated
06/05/2014
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