Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Southeast Ga Primary Prevent

Organization Family Medicine Physician · NPI 1649470410

Southeast Ga Primary Prevent is a Family Medicine Physician in Vidalia, Georgia. Licensed in Georgia. Registered with an NPI since 2007.

Licensed in
GA
In the registry since
2007

Practice location Address checks out

1811 Edwina Dr
Vidalia, GA 30474-8963
Phone: (912) 537-9779
Fax: (912) 537-2124
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 052930 (GA)

Record details

NPI number1649470410
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Lisa Bush — Billing Manager · (912) 537-9779
NPI enumeratedJuly 20, 2007
Last updated in NPPESMay 8, 2008
Mailing address1811 Edwina Dr, Vidalia, GA 30474-8963

Other providers in Vidalia