| Southern Regional Medical Center | |
|
11 Upper Riverdale Rd Sw Riverdale GA 30274-2615 | |
| (770) 991-8160 | |
| (770) 909-2595 |
| Full Name | Southern Regional Medical Center |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 11 Upper Riverdale Rd Sw, Riverdale, Georgia |
| Authorized Official Name and Position | Christopher Doan (COMPLIANCE OFFICER) |
| Authorized Official Contact | 3102594706 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Regional Medical Center 11 Upper Riverdale Rd Sw Riverdale GA 30274-2615 Ph: (770) 991-8160 | Southern Regional Medical Center 11 Upper Riverdale Rd Sw Riverdale GA 30274-2615 Ph: (770) 991-8160 |
| NPI Number | 1518440254 |
|---|---|
| Provider Enumeration Date | 09/10/2018 |
| Last Update Date | 09/10/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518440254 | NPI | - | NPPES |
| 000000404A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | 031-710 (Georgia) | Primary |
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