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General NPI Number Information
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NPI Number | 1962652537
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Entity Type | Organization
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Legal Business Name | SOUTHLAND MEDICAL SOLUTIONS OF ANDALUSIA PL
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Dates
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Enumeration Date | 09/19/2008
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Last Update Date | 09/19/2008
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Provider Practice Location Address
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Address Line | 849 S THREE NOTCH ST
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City | ANDALUSIA
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State | AL
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Zip | 36420-5325
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Country | US
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Telephone | 334-222-8466
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Fax |
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Provider Business Mailing Address
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Address Line | 7004 NW 52ND TER
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City | GAINESVILLE
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State | FL
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Zip | 32653-7008
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Country | US
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Telephone | 205-907-2586
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | PAUL HART
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Credential | MD
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Telephone | 205-907-2586
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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