Vidalia Family Care LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

VIDALIA FAMILY CARE LLC

Practice address

1702 Meadows LN
Vidalia, GA 30474-7219

Phone

(912) 805-2198

Fax

(912) 805-2997

NPI assigned

Dec 4, 2024

Organization subpart

No

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

Authorized official

Name

John Burton Derrick, PA-CNPI 1932253606

Title

Ceo

Phone

(912) 293-3308

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

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.

• John Burton Derrick

  • Medical Physician Assistant
  • Vidalia, GA
  • NPI 1932253606
  Medicare reassignment Care Compare group Authorized official
• Sharifa M Abou-Mediene, MD

  • General Practice Physician
  • Hinesville, GA
  • NPI 1750571956
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1733270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733270400000",
    "number": "1114733250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 645",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304750645",
            "telephone_number": "912-293-3308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1702 MEADOWS LN",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304747219",
            "telephone_number": "912-805-2198",
            "fax_number": "912-805-2997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIDALIA FAMILY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-04",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A",
        "authorized_official_last_name": "DERRICK",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "BURTON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "912-293-3308",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vidalia City Board of Education
• Vidalia Dental Associates,P.C.
• Vidalia ENT Associates, LLC
• Vidalia Eye Associates, Inc.
• Vidalia Eyecare LLC
• Vidalia Family Chiropractic, PC
• Vidalia Family Health Clinic LLC (Southeast Regional Primay Care Corp)
• Vidalia Health Services, LLC
• Vidalia Health Services, LLC (Memorial Health Meadows Hospital Imaging Center)
• Vidalia Health Services, LLC

• Primary Care Clinic/Center in Vidalia, GA
• Providers in Vidalia, GA by specialty
• Primary Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.