SOUTHEAST REGIONAL PRIMARY CARE CORPORATION (NPI# 1336642719) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336642719 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST REGIONAL PRIMARY CARE CORPORATION |
| Other Organization Name | MEADOWS MEDICAL GROUP CARDIOLOGY |
| Practice Address |
101 Harris Industrial Blvd Ste A Vidalia GA 30474-8852 |
| Mailing Address |
Po Box 407 Vidalia GA 30475-0407 |
| Practice Telephone | 9125353500 |
| Mailing Telephone | 9125353500 |
| 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 | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Meadows Medical Group Cardiology | 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 |
| 1790288181 | Southeast Regional Primary Care Corporation | General Acute Care Hospital | 1 Meadows Pkwy, Vidalia, GA 30474-8759 | 2018-03-13 |
| 1053814434 | Southeast Regional Primary Care Corporation | Urology | 303 Harris Industrial Blvd Ste 5, Vidalia, GA 30474-8854 | 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 |
101 HARRIS INDUSTRIAL BLVD STE A |
| City | VIDALIA |
| State | GA |
| Zip Code | 30474-8852 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629064365 | Albert A Burton | Internal Medicine | 101 Harris Industrial Blvd Ste A, Vidalia, GA 30474-8852 | 2005-09-27 |
| 1487161030 | Carla Clark Gay | Nurse Practitioner | 101 Harris Industrial Blvd Ste A, Vidalia, GA 30474-8852 | 2018-01-04 |
| 1942716642 | Terra Hardeman | Nurse Practitioner | 101 Harris Industrial Blvd Ste A, Vidalia, GA 30474-8852 | 2017-12-18 |
| 1164873121 | Pate Chester | Nurse Practitioner | 101 Harris Industrial Blvd Ste A, Vidalia, GA 30474-8852 | 2016-06-30 |
| 1912252792 | Cynthia Kaye Holton | Nurse Practitioner | 101 Harris Industrial Blvd Ste A, Vidalia, GA 30474-8852 | 2012-07-18 |
| 1194732719 | Martha Smith | Internal Medicine | 101 Harris Industrial Blvd Ste A, Vidalia, GA 30474-8852 | 2006-08-03 |
| 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 | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629064365 | Albert A Burton | Internal Medicine | 101 Harris Industrial Blvd Ste A, Vidalia, GA 30474-8852 | 2005-09-27 |
| 1396944633 | Southeastern Cardiology | Internal Medicine | 1811 Edwina Dr, Vidalia, GA 30474-8963 | 2007-07-17 |
| 1417035221 | Kenneth S Marvin | Internal Medicine | 101 Harris Industrial Blvd, Suite A, Vidalia, GA 30474-8852 | 2006-11-01 |
| 1194732719 | Martha Smith | Internal Medicine | 101 Harris Industrial Blvd Ste A, Vidalia, GA 30474-8852 | 2006-08-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013571033 | Norihiko Kamioka | Internal Medicine | 1364 Clifton Rd Ne Ste D422, Atlanta, GA 30322-1059 | 2019-04-24 |
| 1992229884 | Medical Software, LLC | Internal Medicine | 3855 Pleasant Hill Rd Ste 350, Duluth, GA 30096-8093 | 2017-08-01 |
| 1215399456 | Raymond Mai | Internal Medicine | 1120 15th St # 6518, Augusta, GA 30912-1436 | 2016-03-27 |
| 1043684954 | Columbus Cardiology Associates, PC | Internal Medicine | 905 N Jackson St, Ste B, Americus, GA 31719-3089 | 2015-11-17 |
| 1649693045 | Avantgarde Consultants, Inc. | Internal Medicine | 10945 State Bridge Rd Ste 401-708, Alpharetta, GA 30022-8164 | 2014-01-22 |
| 1194153973 | Epic Group 8 | Internal Medicine | 760 Old Roswell Rd, Suite 114, Roswell, GA 30076-2279 | 2013-10-14 |
| 1982940987 | Southeastern Cardiovascular Associates LLC | Internal Medicine | 1076 Bermuda Run, Statesboro, GA 30458-0858 | 2012-12-19 |
| 1265798763 | Sulay Pankaj Patel | Internal Medicine | 101 Woodruff Circle Wmb 1013, Atlanta, GA 30322 | 2012-04-09 |
| 1073879573 | Ozlem Bilen | Internal Medicine | Emory University Cardiovascular, 101 Woodruff Circle, Wmb 3004, Atlanta, GA 30322-0001 | 2012-04-09 |
| 1962779611 | Cardiac Consultants of Central Georgia | Internal Medicine | 2024 Watson Blvd Bldg 1, Warner Robins, GA 31093-3624 | 2011-11-23 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on SOUTHEAST REGIONAL PRIMARY CARE CORPORATION.
| 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.