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NPI Code Detail

MEDICARE: SOUTHEASTERN REGIONAL PHYSICIAN SERVICES

MEDICARE: SOUTHEASTERN REGIONAL PHYSICIAN SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1093389231
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHEASTERN REGIONAL PHYSICIAN SERVICES
Provider Business Mailing Address
First Line : PO BOX 749193
Second Line :
City : ATLANTA
State : GA
Zip : 30374-9193
Country : US
Telephone Number : 984-974-4372
Fax Number :
Provider Business Practice Location Address
First Line : 1249 CHICKEN FOOT RD STE C
Second Line :
City : HOPE MILLS
State : NC
Zip : 28348-7525
Country : US
Telephone Number : 910-779-1967
Fax Number : 910-779-1968
Authorized Official
Title or Position : CRO
Name : CHARLES THOMAS JOHNSON
Credential :
Telephone Number : 910-671-5083
Provider Enumeration Date : 05/13/2021
Last Update Date : 04/28/2025

Similar Medicare Providers

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Practice Location Address:
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1033122668 — DR. MARIA JEANETTE WATSON M.D.
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1073801817 — SHAHLA NAZ M.D.
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1073906228 — SOUTHEASTERN HEALTH PHYSICIAN SERVICES
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1265915763 — CAROL EVANS WALTERS
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Directions to “SOUTHEASTERN REGIONAL PHYSICIAN SERVICES ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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