Type 2 · Organization ✓ Active NPI ✓ Valid NPI checksum

Southeast Ga Primary Prevent

Family Medicine Physician in Vidalia, GA · enumerated 2007 · authorized official Lisa Bush, Billing Manager.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1649470410

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Registry record

Entity type Organization (Type 2)

Legal business name Southeast Ga Primary Prevent

Practice address 1811 Edwina Dr, Vidalia, GA, 30474

Phone (912) 537-9779

Fax (912) 537-2124

Enumeration date Jul 20, 2007

Last updated in NPPES May 8, 2008

Taxonomy & classification

207Q00000X Family Medicine Physician Allopathic & Osteopathic Physicians · License 052930 (GA) Primary

Authorized official

Name Lisa Bush

Title Billing Manager

Phone (912) 537-9779

Other identifiers

Identifier	Type	State	Issuer
000978128I	Medicaid	GA	-

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

Read the full guide → Validate an NPI →

Frequently asked questions

Where is Southeast Ga Primary Prevent located?

The practice location on file with NPPES is in Vidalia, GA.

How current is this record?

Data comes from the CMS NPPES public dissemination file; this record was last updated in NPPES on 2008-05-08. Verify at npiregistry.cms.hhs.gov.

Providers at this address

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2008-05-08.