NPI age
4 years
Enumerated 2021-08-02
● Active Type 2 · Organization
Vidalia Immediate & Primary Care Llc
Vidalia Immediate & Primary Care Llc is 1 of 655 clinic/center organizations in Georgia.
Primary specialty
Clinic/Center
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Beckum
Practice Manager/office Manager
Last NPPES update
2021-11-16
Source: monthly bulk 2026-05
How this organization compares
Across 655 active clinic/center providers in Georgia.
NPI age
4 years
↓ 7 yr below median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2021 → 2026
2021-08Enumerated in NPPES
2021
2026
Where they practice
Primary practice location
122 Alice Coleman Drive
Vidalia, GA 30474
Mailing address
Po Box 2324
Vidalia, GA 304752324
Authorized official
Melissa Ann Beckum
Practice Manager/office Manager
📞 9122932869
Individual providers at this organization
3 individual providers on file at this primary practice address.
- Alexis Fountain, FNP-C Nurse Practitioner NPI 1821724386
- Dewey Howell, FNP-C Nurse Practitioner NPI 1467808279
- Amanda Lariscey, PA-C Physician Assistant NPI 1780164590
Specialties
-
Clinic/Center PrimaryDefinition to come...
Practice context
Multi-provider organization. 3 individual providers on file at this primary address.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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