MEDICARE: SOUTHLAND MEDICAL SOLUTIONS OF AL PL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician
2	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1033379813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHLAND MEDICAL SOLUTIONS OF AL PL

Provider Business Mailing Address
First Line	:	7004 NW 52ND TER
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32653-7008
Country	:	US
Telephone Number	:	205-907-2586
Fax Number	:	205-678-2700

Provider Business Practice Location Address
First Line	:	7004 NW 52ND TER
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32653-7008
Country	:	US
Telephone Number	:	205-907-2586
Fax Number	:	205-678-2700

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	DR. PAUL DUANE HART
Credential	:	M.D.
Telephone Number	:	850-499-0825

Provider Enumeration Date	:	06/14/2008
Last Update Date	:	06/14/2008

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