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General NPI Number Information
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NPI Number | 1386949394
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Entity Type | Organization
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Legal Business Name | SOUTHERN HEALTH MANAGEMENT INC
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Dates
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Enumeration Date | 01/22/2011
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Last Update Date | 01/22/2011
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Provider Practice Location Address
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Address Line | 2060 NORTHLAKE PKWY
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City | TUCKER
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State | GA
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Zip | 30084-7012
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Country | US
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Telephone | 404-981-6337
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Fax | 888-336-7611
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Provider Business Mailing Address
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Address Line | 2060 NORTHLAKE PKWY
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City | TUCKER
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State | GA
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Zip | 30084-7012
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Country | US
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Telephone | 404-981-6337
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY JOHN GONZALEZ
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Credential |
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Telephone | 404-981-6337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 00224953
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License Number State | GA
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