NPIMap

Organization Active NPI

Southeast Georgia Primary Care

  • Family Medicine Physician
  • Waycross, GA
National Provider Identifier
1053429688
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SOUTHEAST GEORGIA PRIMARY CARE
Practice address
409 Uvalda St
Waycross, GA 31501-4574
Phone
(912) 283-1359
Fax
(912) 283-1362
NPI assigned
Aug 25, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Matthew G Prohaska, D.O.
Title
Doctor
Phone
(912) 283-1359

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

409 Uvalda St
Waycross, GA 31501-4574

Mailing address

409 Uvalda St
Waycross, GA 31501-4574
Phone (912) 283-1359

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053429688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 UVALDA ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315014574",
            "telephone_number": "912-283-1359",
            "fax_number": "912-283-1362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 UVALDA ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315014574",
            "telephone_number": "912-283-1359",
            "fax_number": "912-283-1362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST GEORGIA PRIMARY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PROHASKA",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "912-283-1359",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waycross, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.