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General NPI Number Information
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NPI Number | 1942803689
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Entity Type | Organization
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Legal Business Name | SCREVEN PRIMARY CARE
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Dates
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Enumeration Date | 11/17/2020
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Last Update Date | 11/17/2020
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Provider Practice Location Address
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Address Line | 213 MIMS RD
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City | SYLVANIA
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State | GA
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Zip | 30467-1994
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Country | US
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Telephone | 912-303-7729
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Fax | 912-564-2174
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Provider Business Mailing Address
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Address Line | 213 MIMS RD
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City | SYLVANIA
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State | GA
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Zip | 30467-1994
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Country | US
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Telephone | 912-303-7729
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Fax | 912-564-2174
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHERMA PETER
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Credential | MD,
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Telephone | 912-303-7729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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