Organization
VIDALIA ENT 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)
(912) 538-5314
Entity
Organization
Contact information
Practice address
1707 MEADOWS LANE, SUITE C, VIDALIA, GA 30474
(912) 537-3384
(912) 537-3351
Mailing address
PO BOX 407, VIDALIA, GA 30475-0407
(912) 537-3384
(912) 537-3351
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
060338
GA
Other
Enumeration date
01/28/2008
Last updated
09/05/2014
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