Healthcare Provider Details

I. General information

NPI: 1033379813
Provider Name (Legal Business Name): SOUTHLAND MEDICAL SOLUTIONS OF AL PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2008
Last Update Date: 06/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7004 NW 52ND TER
GAINESVILLE FL
32653-7008
US

IV. Provider business mailing address

7004 NW 52ND TER
GAINESVILLE FL
32653-7008
US

V. Phone/Fax

Practice location:
  • Phone: 205-907-2586
  • Fax: 205-678-2700
Mailing address:
  • Phone: 205-907-2586
  • Fax: 205-678-2700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL DUANE HART
Title or Position: PRESIDENT AND CEO
Credential: M.D.
Phone: 850-499-0825