Healthcare Provider Details

I. General information

NPI: 1114795663
Provider Name (Legal Business Name): SOUTHEASTERN RHEUMATOLOGY ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S ENOTA DR NE
GAINESVILLE GA
30501-2403
US

IV. Provider business mailing address

700 S ENOTA DR NE
GAINESVILLE GA
30501-2403
US

V. Phone/Fax

Practice location:
  • Phone: 770-531-3711
  • Fax: 678-696-8386
Mailing address:
  • Phone: 770-531-3711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL CULLEN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 770-531-3711