MEDICARE: SOUTHERN PRIMARY CARE, LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1750219549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN PRIMARY CARE, LLC

Provider Business Mailing Address
First Line	:	197 BASS RD
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31210-2060
Country	:	US
Telephone Number	:	478-477-0966
Fax Number	:	478-254-3146

Provider Business Practice Location Address
First Line	:	101 WILLIE LEE PKWY STE 400
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-9245
Country	:	US
Telephone Number	:	478-477-0966
Fax Number	:	478-254-3146

Authorized Official
Title or Position	:	MD
Name	:	JAYESH PATEL
Credential	:
Telephone Number	:	478-477-0966

Provider Enumeration Date	:	05/12/2026
Last Update Date	:	05/12/2026

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Directions to “SOUTHERN PRIMARY CARE, LLC ” Practice Location

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