Healthcare Provider Details

I. General information

NPI: 1235227737
Provider Name (Legal Business Name): SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 UPPER RIVERDALE RD SW 6TH FLOOR
RIVERDALE GA
30274-2615
US

IV. Provider business mailing address

11 UPPER RIVERDALE RD SW 6TH FLOOR
RIVERDALE GA
30274-2615
US

V. Phone/Fax

Practice location:
  • Phone: 770-897-7603
  • Fax: 770-897-7606
Mailing address:
  • Phone: 770-897-7603
  • Fax: 770-897-7606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number031-614
License Number StateGA

VIII. Authorized Official

Name: CHRISTOPHER KARAM
Title or Position: PRESIDENT & CEO
Credential:
Phone: 713-277-2771