SOUTHEAST REGIONAL PRIMARY CARE CORPORATION (NPI# 1053814434) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053814434 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST REGIONAL PRIMARY CARE CORPORATION |
| Other Organization Name | MEADOWS MEDICAL GROUP UROLOGY |
| Practice Address |
303 Harris Industrial Blvd Ste 5 Vidalia GA 30474-8854 |
| Mailing Address |
Po Box 407 Vidalia GA 30475-0407 |
| Practice Telephone | 9125379481 |
| Mailing Telephone | 9125379481 |
| Enumeration Date | 2018-03-13 |
| Last Update Date | 2018-03-13 |
| Authorized Official Name | TONY M O'STEEN (CFO) |
| Authorized Official Telephone | 9125355560 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Meadows Medical Group Urology | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083117469 | Southeast Regional Primary Care Corporation | Otolaryngology | 1707 Meadows Ln Ste C, Vidalia, GA 30474-7201 | 2018-03-13 |
| 1437652815 | Southeast Regional Primary Care Corporation | Podiatrist | 1707 Meadows Ln Ste H, Vidalia, GA 30474-7201 | 2018-03-13 |
| 1225531197 | Southeast Regional Primary Care Corporation | Internal Medicine | 1811 Edwina Dr, Vidalia, GA 30474-8963 | 2018-03-16 |
| 1336642719 | Southeast Regional Primary Care Corporation | Internal Medicine | 101 Harris Industrial Blvd Ste A, Vidalia, GA 30474-8852 | 2018-03-13 |
| 1790288181 | Southeast Regional Primary Care Corporation | General Acute Care Hospital | 1 Meadows Pkwy, Vidalia, GA 30474-8759 | 2018-03-13 |
| 1134622517 | Southeast Regional Primary Care Corporation | Anesthesiology | 1 Meadows Pkwy, Vidalia, GA 30474-8759 | 2018-03-13 |
| 1790288413 | Southeast Regional Primary Care Corporation | Pediatrics | 125 Church St, Vidalia, GA 30474-4770 | 2018-03-09 |
| 1619470333 | Southeast Regional Primary Care Corporation | Obstetrics & Gynecology | 101 Harris Industrial Blvd Ste C, Vidalia, GA 30474-8852 | 2018-03-09 |
| 1750883435 | Southeast Regional Primary Care Corporation | Internal Medicine | 104 Fairview Park Dr, Dublin, GA 31021-2500 | 2018-03-08 |
| 1063914851 | Southeast Regional Primary Care Corporation | Internal Medicine | 621 E 1st St Ste B, Vidalia, GA 30474-4264 | 2018-03-07 |
| Street Address |
303 HARRIS INDUSTRIAL BLVD STE 5 |
| City | VIDALIA |
| State | GA |
| Zip Code | 30474-8854 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912238460 | Bradley H Young | Nurse Practitioner | 303 Harris Industrial Blvd Ste 5, Vidalia, GA 30474-8854 | 2010-01-22 |
| 1861050890 | Esther J Galletta | Physician Assistant | 303 Harris Industrial Blvd Ste 5, Vidalia, GA 30474-8854 | 2019-06-04 |
| 1679137038 | Colleen Marie Kerrigan | Physician Assistant | 303 Harris Industrial Blvd Ste 5, Vidalia, GA 30474-8854 | 2019-04-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730655374 | Abby Virginia Adams | Speech-Language Pathologist | 101 Harris Insustrial Blvd, Vidalia, GA 30474 | 2018-10-22 |
| 1467930156 | Laurel Shiver Sapp | Nurse Practitioner | 1608 Meadows Ln, Vidalia, GA 30474 | 2018-08-03 |
| 1235658931 | Mary Frances Andrews | Nurse Practitioner | 1608 Meadows Lane Suite 1, Vidalia, GA 30474 | 2017-09-13 |
| 1154714574 | Georgia Eye Institute of The Southeast, LLC | Optometrist | 104 Andrews Street, Suite 112, Vidalia, GA 30474 | 2015-03-10 |
| 1790112571 | Tattnall Hospital Company, LLC | Surgery | 1702-a Meadows Lane, Vidalia, GA 30474 | 2013-10-10 |
| 1801235312 | Paul Anderson Youth Home, Inc. | Substance Abuse Rehabilitation Facility | 1603 Mcintosh Street, Vidalia, GA 30474 | 2013-06-18 |
| 1043591076 | Kimberly Thigpen Evans | Nurse Practitioner | 621 East First Street, Unit B, Vidalia, GA 30474 | 2011-09-03 |
| 1154614360 | Tattnall Hospital Company, LLC | Family Medicine | 1811 Edwina Drive, Vidalia, GA 30474 | 2011-05-20 |
| 1255586053 | Vidalia Medical Partners Inc. | Home Health | 801 Mcnatt Street, Vidalia, GA 30474 | 2008-11-20 |
| 1154596419 | Jill Nicole Lawrence | Speech-Language Pathologist | 1400 Ne Main St, Bethany Alf, Vidalia, GA 30474 | 2008-04-28 |
| Find all providers in zip 30474 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386723492 | Gilbert J. Gonzalez, M.d., LLC | Urology | 303 Harris Industrial Blvd., Suite 5, Vidalia, GA 30474 | 2006-11-02 |
| 1316930464 | Gilbert J. Gonzalez | Urology | 1707 Meadows Ln Ste F, Vidalia, GA 30474-7201 | 2005-08-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942820576 | Advanced Urology Institute of Georgia PC | Urology | 2205 Riverstone Blvd Ste 101, Canton, GA 30114-5250 | 2020-04-23 |
| 1093369795 | Georgia Urology, Pa | Urology | 470 Northside Cherokee Blvd Ste 210, Canton, GA 30115-8029 | 2019-07-31 |
| 1790248953 | Michael Oberle | Urology | 1120 15th St Rm Baa 8415, Augusta, GA 30912-4050 | 2019-04-12 |
| 1598220915 | Effingham Urology, LLC | Urology | 613 Towne Park Dr W Ste 204, Rincon, GA 31326-5183 | 2019-02-11 |
| 1275008351 | Center for Special Surgery LLC | Urology | 11660 Alpharetta Hwy Ste 720, Roswell, GA 30076-4916 | 2018-10-04 |
| 1295200426 | Paul Edward Henson Jr. | Urology | 1837 Wood Valley Dr, Dalton, GA 30720-3846 | 2018-10-03 |
| 1477033124 | Urological Health Center, PC | Urology | 1770 Watson Boulevard, Warner Robins, GA 31093 | 2018-08-21 |
| 1982182655 | Advanced Urology Institute of Georgia | Urology | 1460 S Johnson Ferry Rd, Atlanta, GA 30319-4301 | 2018-08-03 |
| 1922597517 | Wguasc, LLC | Urology | 150 Clinic Ave Ste 203, Carrollton, GA 30117-4402 | 2018-05-09 |
| 1841788395 | Houston Physician Specialists, LLC | Urology | 233 N Houston Rd Ste 100, Warner Robins, GA 31093-8944 | 2018-04-30 |
| Find all providers with the same taxonomy | ||||
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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.