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General NPI Number Information
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NPI Number | 1245111814
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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 | 09/10/2025
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 1499 FOREST HILL BLVD STE 112
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City | WEST PALM BEACH
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State | FL
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Zip | 33406-6050
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Country | US
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Telephone | 407-761-8640
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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 | MD
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Name | JAYESH PATEL
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Credential |
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Telephone | 478-477-0966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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