Organization
VIDALIA CHILDREN'S CENTER LLC
Active
Parent organization
SOUTHEADT REGIONAL PRIMARY CARE CORPORATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHEADT REGIONAL PRIMARY CARE CORPORATION
Authorized official
TONY M OSTEEN CFO (CFO)
(912) 538-5314
Entity
Organization
Contact information
Practice address
125 CHURCH STREET, VIDALIA, GA 30474
(912) 538-8484
(912) 538-8665
Mailing address
PO BOX 407, VIDALIA, GA 30475-0407
(912) 538-8484
(912) 538-8665
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
08/18/2009
Last updated
09/05/2014
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