Provider Demographics
NPI:1427126614
Name:SOUTHEAST GERIATRICS INC
Entity type:Organization
Organization Name:SOUTHEAST GERIATRICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-285-4022
Mailing Address - Street 1:160 SPRING BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-0356
Mailing Address - Country:US
Mailing Address - Phone:478-274-0269
Mailing Address - Fax:888-326-5817
Practice Address - Street 1:160 SPRING BRANCH DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-0356
Practice Address - Country:US
Practice Address - Phone:478-274-0269
Practice Address - Fax:888-326-5817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033213313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA38BDBFHMedicare ID - Type UnspecifiedMEDICARE
GAE81474Medicare UPIN