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General NPI Number Information
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NPI Number | 1477986107
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Entity Type | Organization
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Legal Business Name | SOUTHERN EMERGENCY PHYSICIANS, LLP
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Dates
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Enumeration Date | 08/16/2013
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Last Update Date | 08/16/2013
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Provider Practice Location Address
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Address Line | 1077 S MAIN ST
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City | MADISON
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State | GA
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Zip | 30650-2073
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Country | US
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Telephone | 866-916-5259
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Fax | 231-922-4030
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Provider Business Mailing Address
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Address Line | 75 REMIT DR SUITE 1209
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City | CHICAGO
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State | IL
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Zip | 60675-1209
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Country | US
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Telephone | 866-916-5259
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Fax | 231-922-4030
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Authorized Official
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Title or Position | LLP MANGING PARTNER
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Name | DERIK K KING
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Credential | MD
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Telephone | 866-916-5259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist 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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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