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General NPI Number Information
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NPI Number | 1356464036
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Entity Type | Organization
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Legal Business Name | SOUTHLAND TOTAL HEALTHCARE SYSTEMS, INC.
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 09/18/2007
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Provider Practice Location Address
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Address Line | 2046 BELTLINE RD SW
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City | DECATUR
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State | AL
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Zip | 35601-5549
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Country | US
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Telephone | 256-353-0410
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Fax | 256-353-0649
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Provider Business Mailing Address
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Address Line | 2046 BELTLINE RD SW
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City | DECATUR
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State | AL
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Zip | 35601-5549
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Country | US
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Telephone | 256-353-0410
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Fax | 256-353-0649
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DR. WILATRA AWONIYI
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Credential | D.D.S.
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Telephone | 256-353-0410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3912
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207VH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician
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License Number | 9604
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License Number State | AL
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