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General NPI Number Information
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NPI Number | 1114956075
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Entity Type | Organization
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Legal Business Name | SOUTHCARE MEDICAL CENTER
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 809 PEACHTREE ST
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City | LOUISVILLE
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State | GA
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Zip | 30434-1449
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Country | US
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Telephone | 478-625-7597
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Fax | 478-625-8364
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Provider Business Mailing Address
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Address Line | 2514 TOBACCO RD STE C
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City | HEPHZIBAH
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State | GA
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Zip | 30815-7005
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Country | US
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Telephone | 706-790-0311
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Fax | 706-790-0815
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FIROZ PATKA
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Credential | M.D.
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Telephone | 478-625-7597
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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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