Pineland Mh/Mr/Sa Csb

Clinic / Center · Vidalia, GA

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At a glance

901 North St W, Vidalia, GA 30474-3503

NPPES record updated May 1, 2008. Public records can lag behind changes at a practice.

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Practice location

901 North St W
Vidalia, GA 30474-3503

Professional details: NPI, taxonomy & registry record

NPI1760658587

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Registry details

Primary taxonomy: Clinic / Center
Taxonomy code: 261Q00000X
Enumeration date: May 1, 2008
Record updated: May 1, 2008

More registry details

Provider type: Organization · Type 2

Reported taxonomies and licenses

Clinic / Center

261Q00000X · Primary

License reported: LPN068072 GA

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

901 North St W
Vidalia, GA 30474-3503

Phone: (912) 537-9316
Fax: (912) 537-9915

Mailing address

5 W ALTMAN ST

STATESBORO, GA 304585212

Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.

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