Healthcare Provider Details

I. General information

NPI: 1144480146
Provider Name (Legal Business Name): SOUTHCARE PHYSICIANS GROUP OBSTETRICS & GYNECOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3885 PRINCETON LAKES WAY SW SUITE 412
ATLANTA GA
30331-5589
US

IV. Provider business mailing address

3885 PRINCETON LAKES WAY SW SUITE 412
ATLANTA GA
30331-5589
US

V. Phone/Fax

Practice location:
  • Phone: 404-466-1006
  • Fax:
Mailing address:
  • Phone: 404-466-1006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. WESLEY O. JAMES
Title or Position: REGIONAL CFO, TENET
Credential:
Phone: 404-265-5009