| Southeastern Medical Group, P.a. | |
|
637 S Kerr Ave Wilmington NC 28403-8423 | |
| (910) 799-1810 | |
| (910) 452-2571 |
| Full Name | Southeastern Medical Group, P.a. |
|---|---|
| Speciality | Internal Medicine |
| Location | 637 S Kerr Ave, Wilmington, North Carolina |
| Authorized Official Name and Position | Patricia Mayes Wilson (OFFICE MANAGER) |
| Authorized Official Contact | 9107991810 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeastern Medical Group, P.a. 637 S Kerr Ave Wilmington NC 28403-8423 Ph: (910) 799-1810 | Southeastern Medical Group, P.a. 637 S Kerr Ave Wilmington NC 28403-8423 Ph: (910) 799-1810 |
| NPI Number | 1265479091 |
|---|---|
| Provider Enumeration Date | 06/01/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265479091 | NPI | - | NPPES |
| 02701 | Other | NC | BLUE CROSS BLUE SHIELD |
| 8902701 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 16755 (North Carolina) | Primary |
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