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General NPI Number Information
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NPI Number | 1225551328
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Entity Type | Organization
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Legal Business Name | SOUTHERN PRIMARY CARE, LLC
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Dates
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Enumeration Date | 07/20/2017
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Last Update Date | 01/21/2024
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Provider Practice Location Address
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Address Line | 197 BASS RD
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City | MACON
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State | GA
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Zip | 31210-2060
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Country | US
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Telephone | 478-365-2164
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Fax |
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Provider Business Mailing Address
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Address Line | 197 BASS RD
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City | MACON
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State | GA
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Zip | 31210-2060
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | JAYESH D PATEL
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Credential | MD
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Telephone | 478-365-2164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0201X
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Taxonomy Name | Allergy & Immunology (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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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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