Provider Demographics
NPI:1801975990
Name:SOUTHEAST GEORGIA UROLOGY ASSOCIATES PC
Entity type:Organization
Organization Name:SOUTHEAST GEORGIA UROLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:SHEA
Authorized Official - Last Name:LANZONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-261-0447
Mailing Address - Street 1:2500 STARLING ST
Mailing Address - Street 2:SUITE 406
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4265
Mailing Address - Country:US
Mailing Address - Phone:912-261-0447
Mailing Address - Fax:
Practice Address - Street 1:2500 STARLING ST
Practice Address - Street 2:SUITE 406
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4265
Practice Address - Country:US
Practice Address - Phone:912-261-0447
Practice Address - Fax:912-261-1847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty