SOUTHEAST GEORGIA PRIMARY CARE (NPI# 1053429688) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053429688 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST GEORGIA PRIMARY CARE |
| Practice Address |
409 Uvalda St Waycross GA 31501-4574 |
| Practice Telephone | 9122831359 |
| Practice Fax Number | 9122831362 |
| Mailing Telephone | 9122831359 |
| Mailing Fax Number | 9122831362 |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. MATTHEW G PROHASKA (DOCTOR) |
| Authorized Official Telephone | 9122831359 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Street Address |
409 UVALDA ST |
| City | WAYCROSS |
| State | GA |
| Zip Code | 31501-4574 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801903596 | Ellisa A Mathis | Nurse Practitioner | 409 Uvalda St, Waycross, GA 31501-4574 | 2006-08-25 |
| 1467814228 | Frank Schly Eldridge Iv | Nurse Practitioner | 409 Uvalda St, Waycross, GA 31501-4574 | 2016-03-22 |
| 1508988098 | Leslie C. Taylor | Nurse Practitioner | 409 Uvalda St, Waycross, GA 31501-4574 | 2007-04-04 |
| 1316043227 | Amanda Mccook | Physician Assistant | 409 Uvalda St, Waycross, GA 31501-4574 | 2006-09-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962906115 | Davenport Health Pa | Family Medicine | 1401 Cherokee Drive, Waycross, GA 31501 | 2018-03-22 |
| 1962940478 | Blake Darren Aldridge | Physical Therapy Assistant | 401 Preston Street, Waycross, GA 31501 | 2017-02-03 |
| 1669922142 | Jebediah S. Christy Dds - Waycross Pllc | Dentist | 2271 Memorial Dr, Waycross, GA 31501 | 2016-10-10 |
| 1558721944 | Jana Kirby | Massage Therapist | 1599 Knight Ave., Kallman Chiropractic Center, Waycross, GA 31501 | 2016-02-29 |
| 1962877001 | Courtney Baldwin | Specialist/Technologist, Other | 2403 Spurgeon St, Waycross, GA 31501 | 2015-12-01 |
| 1912389784 | Grayson Stuart Griffis | Dentist | 2103 Tebeau St., Waycross, GA 31501 | 2015-06-29 |
| 1730561267 | Trishla Amit Desai | Internal Medicine | Memorial Satilla Health, 1900 Tebeau Street, Waycross, GA 31501 | 2015-06-20 |
| 1316330913 | Hanger Prosthetics & Orthotics, Inc. | Prosthetic/Orthotic Supplier | 512 City Blvd Ste H, Waycross, GA 31501 | 2015-03-06 |
| 1942699079 | Jose Ramon Martinez | Anesthesiology | 701 City Blvd, Waycross, GA 31501 | 2015-01-13 |
| 1023356714 | Orthopedics Surgeons of Georgia, LLC | Orthopaedic Surgery | 2015 Alice Street, Waycross, GA 31501 | 2013-01-30 |
| Find all providers in zip 31501 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962906115 | Davenport Health Pa | Family Medicine | 1401 Cherokee Drive, Waycross, GA 31501 | 2018-03-22 |
| 1063654929 | Peter Wrobel Md PC | Family Medicine | 1718 Reynolds St, Waycross, GA 31501-1065 | 2009-03-24 |
| 1932126554 | Kalpana Nayak | Family Medicine | 615 Pendleton St Ste 2, Waycross, GA 31501-4724 | 2006-07-17 |
| 1396761987 | Peter Wrobel | Family Medicine | 1718 Reynolds Street, Waycross, GA 31501-4574 | 2006-07-15 |
| 1134164452 | Satilla Family Medicine, P.C. | Family Medicine | 407 W Oneida St, Waycross, GA 31501-5320 | 2006-06-19 |
| 1265490098 | Bradley Daniel Page | Family Medicine | 2005 Pioneer St Ste C, Waycross, GA 31501-6205 | 2006-05-02 |
| 1891752473 | Waycross Family Practice | Family Medicine | 1507 Alice St, Waycross, GA 31501-4530 | 2006-04-27 |
| 1467426023 | Lina Heath Harper | Family Medicine | 303 Darling Ave, Waycross, GA 31501-5223 | 2006-02-13 |
| 1518951953 | Doctors' Office Md PC | Family Medicine | 2015 Alice St, Waycross, GA 31501-6209 | 2005-08-31 |
| 1881181808 | Integrity Health and Wellness, LLC | Family Medicine | 808 Beacon St, Waycross, GA 31501-7104 | 2018-04-16 |
| Find all providers in WAYCROSS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.