Organization
THE ENDOSCOPY CENTER OF SOUTHEAST GEORGIA, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIXIE LOUISE CALHOUN BSN (ADMINISTRATOR)
(912) 538-1003
Entity
Organization
Contact information
Practice address
200 MAPLE DR, VIDALIA, GA 30474-8907
(912) 538-1003
(912) 537-9843
Mailing address
200 MAPLE DR, VIDALIA, GA 30474-8907
(912) 538-1003
(912) 537-9843
Taxonomy
Speciality
Code
Description
License number
State
261QE0800X
Endoscopy Clinic/Center
Primary
138082
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000590147A
—
GA
Enumeration date
06/28/2005
Last updated
01/29/2014
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