Provider Demographics
NPI:1831426360
Name:SOUTHEAST GEORGIA NEUROLOGICAL CENTERS, PC
Entity type:Organization
Organization Name:SOUTHEAST GEORGIA NEUROLOGICAL CENTERS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:KIMBLE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:912-308-0444
Mailing Address - Street 1:PO BOX 15694
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-2394
Mailing Address - Country:US
Mailing Address - Phone:912-354-7553
Mailing Address - Fax:912-354-7559
Practice Address - Street 1:1 OGLETHORPE PROFESSIONAL BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4883
Practice Address - Country:US
Practice Address - Phone:912-354-7553
Practice Address - Fax:912-354-7559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0632312084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty