Healthcare Provider Details

I. General information

NPI: 1750219549
Provider Name (Legal Business Name): SOUTHERN PRIMARY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WILLIE LEE PKWY STE 400
WARNER ROBINS GA
31088-9245
US

IV. Provider business mailing address

197 BASS RD
MACON GA
31210-2060
US

V. Phone/Fax

Practice location:
  • Phone: 478-477-0966
  • Fax: 478-254-3146
Mailing address:
  • Phone: 478-477-0966
  • Fax: 478-254-3146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JAYESH PATEL
Title or Position: MD
Credential:
Phone: 478-477-0966