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General NPI Number Information
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NPI Number | 1194913053
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Entity Type | Organization
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Legal Business Name | SOUTH METRO PRIMARY CARE
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 261 MEDICAL WAY SUITE A
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City | RIVERDALE
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State | GA
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Zip | 30274-2522
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Country | US
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Telephone | 770-907-0070
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Fax | 770-996-5950
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Provider Business Mailing Address
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Address Line | 261 MEDICAL WAY SUITE A
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City | RIVERDALE
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State | GA
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Zip | 30274-2522
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Country | US
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Telephone | 770-907-0070
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Fax | 770-996-5950
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Authorized Official
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Title or Position | RN/OFFICE MANAGER
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Name | LINDA LOFTON
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Credential |
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Telephone | 770-907-0070
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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 |
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License Number State |
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