SOUTHEASTERN UROLOGY ASSOCIATES NPI 1962538850

NPI Information

  • NPI: 1962538850
  • Provider Name: SOUTHEASTERN UROLOGY ASSOCIATES
  • Classification: Urology - 208800000X
  • Entity Type: Organization
  • Address: 380 HOSPITAL DR
    STE 320
    MACON, GA
    ZIP 31217
  • Phone: (478) 742-5331

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NPI Details

SOUTHEASTERN UROLOGY ASSOCIATES is an urology in Macon, GA. The provider is a urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. SOUTHEASTERN UROLOGY ASSOCIATES NPI is 1962538850. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

380 HOSPITAL DR
STE 320
MACON, GA
ZIP 31217-001
Phone: (478) 742-5331
Fax: (478) 750-1387

The provider's authorized official is W Winston Wilfong .
The authorized official title is President and has the following contact phone number (478) 742-5331.

The enumeration date for this NPI number is 2/26/2007 and was last updated on 6/4/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208800000XUrologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1340005163OTHERGEORGIARR MEDICARE-WILFONG
2GRP1446MEDICARE PINGEORGIA
3340007314OTHERGEORGIARR MEDICARE PATTERSON
4CL8455OTHERGEORGIARR MEDICARE GRP #
5258968966AMEDICARE PINGEORGIA
634BDDQCMEDICARE PINGEORGIA
71659407567MEDICARE PINGEORGIA
834BDBNWMEDICARE PINGEORGIA

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This page was last updated on: 11/21/2025

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