Organization
SOUTHEASTERN UROLOGY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
W WINSTON WILFONG MD (PRESIDENT)
(478) 742-5331
Entity
Organization
Contact information
Practice address
380 HOSPITAL DR, STE 320, MACON, GA 31217-8001
(478) 742-5331
(478) 750-1387
Mailing address
380 HOSPITAL DR, STE 320, MACON, GA 31217-8001
(478) 742-5331
(478) 750-1387
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
340005163
RR MEDICARE-WILFONG
GA
01
—
340007314
RR MEDICARE PATTERSON
GA
01
—
CL8455
RR MEDICARE GRP #
GA
Enumeration date
02/26/2007
Last updated
06/04/2009
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