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General NPI Number Information
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NPI Number | 1750219549
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Entity Type | Organization
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Legal Business Name | SOUTHERN PRIMARY CARE, LLC
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Dates
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Enumeration Date | 05/12/2026
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Last Update Date | 05/12/2026
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Provider Practice Location Address
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Address Line | 101 WILLIE LEE PKWY STE 400
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City | WARNER ROBINS
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State | GA
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Zip | 31088-9245
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Country | US
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Telephone | 478-477-0966
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Fax | 478-254-3146
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Provider Business Mailing Address
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Address Line | 197 BASS RD
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City | MACON
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State | GA
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Zip | 31210-2060
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Country | US
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Telephone | 478-477-0966
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Fax | 478-254-3146
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Authorized Official
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Title or Position | MD
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Name | JAYESH PATEL
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Credential |
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Telephone | 478-477-0966
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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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