| Vidalia Internal Medicine | |
|
210 Mose Coleman Dr Vidalia GA 30474-8677 | |
| (912) 537-2200 | |
| (912) 537-2260 |
| Full Name | Vidalia Internal Medicine |
|---|---|
| Speciality | Internal Medicine |
| Location | 210 Mose Coleman Dr, Vidalia, Georgia |
| Authorized Official Name and Position | Misty D Poole (OWNER) |
| Authorized Official Contact | 9125372200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vidalia Internal Medicine 210 Mose Coleman Dr Vidalia GA 30474-8677 Ph: (912) 537-2200 | Vidalia Internal Medicine 210 Mose Coleman Dr Vidalia GA 30474-8677 Ph: (912) 537-2200 |
| NPI Number | 1003176546 |
|---|---|
| Provider Enumeration Date | 05/17/2012 |
| Last Update Date | 10/09/2015 |
| Medicare PECOS PAC ID | 4183871437 |
|---|---|
| Medicare Enrollment ID | O20120822000183 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003176546 | NPI | - | NPPES |
| 2021111317 | Other | GA | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Misty D Poole |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134358419 PECOS PAC ID: 7810144177 Enrollment ID: I20120822000427 |
| Provider Name | Elisabeth Ann Proenza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619591120 PECOS PAC ID: 5294153342 Enrollment ID: I20200922001434 |
Wheeler County Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 104 Maple Dr, Vidalia, GA 30474 Phone: 912-537-0616 Fax: 912-537-0617 | |
Meadows Medical Group Internal Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 621 E 1st St Ste B, Vidalia, GA 30474 Phone: 912-535-5120 | |
Optim Primary Care-vidalia Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1811 Edwina Drive, Vidalia, GA 30474 Phone: 912-537-9779 Fax: 912-537-2124 | |
Wiggins Family Practice Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 205 Arlington Dr, Vidalia, GA 30474 Phone: 912-537-2530 Fax: 912-537-2540 | |
Vidalia Neurology Associates, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1707 Meadows Lane, Suite A, Vidalia, GA 30474 Phone: 912-537-9779 | |
Williams Rural Surgical & Medical Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1604 Meadows Ln, Vidalia, GA 30474 Phone: 912-245-4179 Fax: 912-403-3346 |