Organization
VIDALIA FAMILY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN BURTON DERRICK PA-C (CEO)
(912) 293-3308
Entity
Organization
Contact information
Practice address
1702 MEADOWS LN, VIDALIA, GA 30474-7219
(912) 805-2198
(912) 805-2997
Mailing address
PO BOX 645, VIDALIA, GA 30475-0645
(912) 293-3308
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
12/04/2024
Last updated
12/04/2024
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