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General NPI Number Information
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NPI Number | 1114146677
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Entity Type | Organization
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Legal Business Name | SOUTHERN HOSPITAL PHYSICIANS,LLC
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 135 BLACKLAND CT E
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City | MARIETTA
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State | GA
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Zip | 30067
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Country | US
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Telephone | 404-313-0515
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Fax | 678-540-5473
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Provider Business Mailing Address
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Address Line | PO BOX 54424
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City | ATLANTA
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State | GA
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Zip | 30308-0424
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Country | US
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Telephone | 770-458-1594
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Fax | 770-458-1596
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Authorized Official
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Title or Position | MANAGER
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Name | KENNETH R. WARNER
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Credential |
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Telephone | 404-313-0515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 047899
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License Number State | GA
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