MEDICARE: TENET SOUTH FULTON INC.

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	207Q00000X	Family Medicine Physician
2	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1326084278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENET SOUTH FULTON INC.

Provider Business Mailing Address
First Line	:	1920 JOHN WESLEY AVE
Second Line	:
City	:	COLLEGE PARK
State	:	GA
Zip	:	30337-3606
Country	:	US
Telephone Number	:	404-765-4164
Fax Number	:	404-762-4897

Provider Business Practice Location Address
First Line	:	3699 BAKERS FERRY RD SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-3712
Country	:	US
Telephone Number	:	404-765-4164
Fax Number	:	404-762-4897

Authorized Official
Title or Position	:	REGIONAL CFO, TENET
Name	:	MR. WESLEY O. JAMES
Credential	:
Telephone Number	:	404-265-5009

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	07/28/2016

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