Organization
SOUTHEAST GEORGIA PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EUGENE WYNN KALLAY II M.D. (OWNER)
(478) 737-7653
Entity
Organization
Contact information
Practice address
1701 BOULEVARD SQ STE D, WAYCROSS, GA 31501-8022
(912) 387-0445
(912) 226-3513
Mailing address
1701 BOULEVARD SQ STE D, WAYCROSS, GA 31501-8022
(912) 387-0445
(912) 226-3513
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
018950
GA
261QP2300X
Primary Care Clinic/Center
041044
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063595973
NPI
—
01
—
1780767665
NPI
—
Enumeration date
06/08/2012
Last updated
06/15/2020
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