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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