MEDICARE: SOUTHCARE PHYSICIANS GROUP OBSTETRICS & GYNECOLOGY

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
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1144480146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHCARE PHYSICIANS GROUP OBSTETRICS & GYNECOLOGY

Provider Business Mailing Address
First Line	:	3885 PRINCETON LAKES WAY SW
Second Line	:	SUITE 412
City	:	ATLANTA
State	:	GA
Zip	:	30331-5589
Country	:	US
Telephone Number	:	404-466-1006
Fax Number	:

Provider Business Practice Location Address
First Line	:	3885 PRINCETON LAKES WAY SW
Second Line	:	SUITE 412
City	:	ATLANTA
State	:	GA
Zip	:	30331-5589
Country	:	US
Telephone Number	:	404-466-1006
Fax Number	:

Authorized Official
Title or Position	:	REGIONAL CFO, TENET
Name	:	MR. WESLEY O. JAMES
Credential	:
Telephone Number	:	404-265-5009

Provider Enumeration Date	:	06/12/2008
Last Update Date	:	06/23/2016

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