Healthcare Provider Details

I. General information

NPI: 1053420109
Provider Name (Legal Business Name): SOUTH METRO IMMEDIATE CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2841 GREENBRIAR PKWY SW SUITE 126
ATLANTA GA
30331-2620
US

IV. Provider business mailing address

2841 GREENBRIAR PKWY SW SUITE 126
ATLANTA GA
30331-2620
US

V. Phone/Fax

Practice location:
  • Phone: 404-346-7162
  • Fax: 404-346-7207
Mailing address:
  • Phone: 404-346-7162
  • Fax: 404-346-7207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number27494
License Number StateGA

VIII. Authorized Official

Name: HELENA K BENTLEY
Title or Position: OWNER
Credential: MD
Phone: 404-346-7162