| Fairburn Southpark Medical And Surgical Clinic | |
|
204 Senoia Rd Fairburn GA 30213-1536 | |
| (770) 964-9759 | |
| (770) 964-7001 |
| Full Name | Fairburn Southpark Medical And Surgical Clinic |
|---|---|
| Speciality | Clinic/center |
| Location | 204 Senoia Rd, Fairburn, Georgia |
| Authorized Official Name and Position | Renato Chaves Souza (PRESIDENT TREASURER) |
| Authorized Official Contact | 7709649759 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fairburn Southpark Medical And Surgical Clinic 204 Senoia Rd Fairburn GA 30213-1536 Ph: (770) 964-9759 | Fairburn Southpark Medical And Surgical Clinic 204 Senoia Rd Fairburn GA 30213-1536 Ph: (770) 964-9759 |
| NPI Number | 1780739318 |
|---|---|
| Provider Enumeration Date | 01/24/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780739318 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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