MEDICARE: SOUTHERN LIGHT OSTEOPATHIC WELLNESS & HEALTHCARE ASSOCIATES, INC.

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	261QU0200X	Urgent Care Clinic/Center	042536	GA
2	261QM2500X	Medical Specialty Clinic/Center	042536	GA

General Provider Information

NPI Number	:	1235204603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN LIGHT OSTEOPATHIC WELLNESS & HEALTHCARE ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1979
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-1979
Country	:	US
Telephone Number	:	912-756-7014
Fax Number	:	912-756-7037

Provider Business Practice Location Address
First Line	:	4164 COASTAL HWY US 17 S
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324
Country	:	US
Telephone Number	:	912-756-7014
Fax Number	:	912-756-7037

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. THOMAS RAYMOND BYRNES JR.
Credential	:	D.O.
Telephone Number	:	972-756-7014

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	09/11/2025

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Directions to “SOUTHERN LIGHT OSTEOPATHIC WELLNESS & HEALTHCARE ASSOCIATES, INC. ” Practice Location

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