Organization
VIDALIA NEUROLOGY ASSOCIATES, LLC
Active
Organization
VIDALIA NEUROLOGY ASSOCIATES, LLC
Active
Parent organization
SOUTHEAST PRIMARY CARE CORPORATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHEAST PRIMARY CARE CORPORATION
Authorized official
TONY M OSTEEN (CFO)
(912) 538-5314
Entity
Organization
Contact information
Practice address
1707 MEADOWS LANE, SUITE A, VIDALIA, GA 30474-7200
(912) 537-9779
Mailing address
PO BOX 407, VIDALIA, GA 30475-0407
(912) 537-4986
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
08/21/2013
Last updated
09/05/2014
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