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General NPI Number Information
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NPI Number | 1548013659
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Entity Type | Organization
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Legal Business Name | SOUTHERN CRESCENT MEDICAL SERVICES
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Dates
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Enumeration Date | 04/09/2024
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 123 N 18TH ST STE 100
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City | GRIFFIN
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State | GA
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Zip | 30223-2264
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Country | US
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Telephone | 678-688-8264
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Fax |
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Provider Business Mailing Address
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Address Line | 626 OLD MILNER RD
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City | BARNESVILLE
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State | GA
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Zip | 30204-3250
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Country | US
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Telephone | 678-858-6615
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LORI WILSON GROGAN
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Credential | NP
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Telephone | 678-858-6615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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