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General NPI Number Information
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NPI Number | 1346596574
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN REGIONAL MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 07/25/2012
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Last Update Date | 03/08/2024
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Provider Practice Location Address
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Address Line | 600 CELEBRATE LIFE PKWY STE A176A
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City | NEWNAN
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State | GA
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Zip | 30265-8001
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Country | US
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Telephone | 770-400-6392
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Fax | 404-348-0453
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Provider Business Mailing Address
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Address Line | 320 S POLK ST STE 200
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City | AMARILLO
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State | TX
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Zip | 79101-1436
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Country | US
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Telephone | 806-242-7782
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Fax | 404-348-0453
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Authorized Official
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Title or Position | PRESIDENT OF PHARMACY SERVICES
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Name | JOEL WRIGHT
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Credential |
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Telephone | 806-242-7782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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