Healthcare Provider Details

I. General information

NPI: 1801908157
Provider Name (Legal Business Name): SOUTHERN MEDICAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5329 N HENRY BLVD
STOCKBRIDGE GA
30281-3224
US

IV. Provider business mailing address

5329 N HENRY BLVD STE 221
STOCKBRIDGE GA
30281-3224
US

V. Phone/Fax

Practice location:
  • Phone: 678-289-9988
  • Fax: 678-383-9945
Mailing address:
  • Phone: 678-289-9988
  • Fax: 678-383-9945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHIRAG R PATEL
Title or Position: PRESIDENT
Credential: MD
Phone: 404-761-1550