Organization
SOUTHERN MEDICAL ASSOCIATES, LLC
Active
Parent organization
SOUTHEAST REGIONAL PRIMARY CARE CORPORATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHEAST REGIONAL PRIMARY CARE CORPORATION
Authorized official
TONY M OSTEEN (CFO VP FINANCE)
(912) 538-5314
Entity
Organization
Contact information
Practice address
601 S VETERANS BLVD, GLENNVILLE, GA 30427-1775
(912) 654-0475
(912) 654-0486
Mailing address
PO BOX 407, VIDALIA, GA 30475-0407
(912) 537-4986
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
054519
GA
Other
Enumeration date
01/24/2014
Last updated
09/04/2014
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