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General NPI Number Information
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NPI Number | 1083785349
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Entity Type | Organization
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Legal Business Name | SOUTHERN FAMILY MEDICAL CENTER PC
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 12/07/2012
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Provider Practice Location Address
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Address Line | 3736 MIKE PADGETT HWY STE A
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City | AUGUSTA
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State | GA
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Zip | 30906-0720
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Country | US
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Telephone | 706-560-2273
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Fax | 706-560-0903
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Provider Business Mailing Address
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Address Line | 3736 MIKE PADGETT HWY STE A
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City | AUGUSTA
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State | GA
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Zip | 30906-0720
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Country | US
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Telephone | 706-560-2273
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Fax | 706-560-0903
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MIKE HODNICK
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Credential |
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Telephone | 706-560-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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