| Southeast Georgia Pediatrics | |
|
1701 Boulevard Sq Ste D Waycross GA 31501-8022 | |
| (912) 387-0445 | |
| (912) 226-3513 |
| Full Name | Southeast Georgia Pediatrics |
|---|---|
| Speciality | Clinic/Center |
| Location | 1701 Boulevard Sq Ste D, Waycross, Georgia |
| Authorized Official Name and Position | Eugene Wynn Kallay (OWNER) |
| Authorized Official Contact | 4787377653 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeast Georgia Pediatrics 1701 Boulevard Sq Ste D Waycross GA 31501-8022 Ph: (912) 387-0445 | Southeast Georgia Pediatrics 1701 Boulevard Sq Ste D Waycross GA 31501-8022 Ph: (912) 387-0445 |
| NPI Number | 1457613192 |
|---|---|
| Provider Enumeration Date | 06/08/2012 |
| Last Update Date | 06/15/2020 |
| Medicare PECOS PAC ID | 6406167212 |
|---|---|
| Medicare Enrollment ID | O20150622000072 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457613192 | NPI | - | NPPES |
| 1780767665 | Other | NPI | |
| 1063595973 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 041044 (Georgia) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | 018950 (Georgia) | Primary |
| Provider Name | Eugene Wynn Kallay |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1063595973 PECOS PAC ID: 9931410719 Enrollment ID: I20150619001483 |
David H. Cheatham, M.d.,p.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 801 Beacon St, Waycross, GA 31501 Phone: 912-285-2440 Fax: 912-287-0197 | |
Southeast Georgia Primary Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 409 Uvalda St, Waycross, GA 31501 Phone: 912-283-1359 Fax: 912-283-1362 | |
Thornton Family Chiropractic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 401 Stephenson St, Waycross, GA 31501 Phone: 912-283-6043 Fax: 912-283-6043 | |
Southeast Internal Medicine Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 406 Riverside Dr, Waycross, GA 31501 Phone: 912-287-1555 | |
Packer Medical Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 709 Knight Ave, Waycross, GA 31501 Phone: 912-283-2311 Fax: 912-283-8204 | |
Satilla Family Medicine, P.c. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 407 W Oneida St, Waycross, GA 31501 Phone: 912-338-0065 Fax: 912-338-0920 | |
Waycross Internal Medicine Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 711 Knight Ave, Waycross, GA 31501 Phone: 912-283-9423 Fax: 912-283-8204 |