| Southern Crescent Medical Center, Llc | |
|
3579 Highway 138 Se Ste 103 Stockbridge GA 30281-4127 | |
| (770) 629-4374 | |
| (678) 545-1735 |
| Full Name | Southern Crescent Medical Center, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 3579 Highway 138 Se Ste 103, Stockbridge, Georgia |
| Authorized Official Name and Position | Shantel Bryant (OWNER) |
| Authorized Official Contact | 7706294374 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Crescent Medical Center, Llc 3579 Highway 138 Se Ste 103 Stockbridge GA 30281-4127 Ph: (770) 629-4374 | Southern Crescent Medical Center, Llc 3579 Highway 138 Se Ste 103 Stockbridge GA 30281-4127 Ph: (770) 629-4374 |
| NPI Number | 1578111910 |
|---|---|
| Provider Enumeration Date | 08/29/2019 |
| Last Update Date | 06/21/2021 |
| Medicare PECOS PAC ID | 9032541289 |
|---|---|
| Medicare Enrollment ID | O20191109000016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578111910 | NPI | - | NPPES |
| 003227501A | Medicaid | GA |
| Provider Name | James Rogan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982704300 PECOS PAC ID: 5597740217 Enrollment ID: I20040618000574 |
| Provider Name | Clayton M Ramsue |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659549103 PECOS PAC ID: 0749259604 Enrollment ID: I20040928000306 |
| Provider Name | Wendy Wright |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386642684 PECOS PAC ID: 5991758369 Enrollment ID: I20050225000035 |
| Provider Name | Harold A Minerve |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1184837841 PECOS PAC ID: 0143268805 Enrollment ID: I20050422000150 |
| Provider Name | Chandra R Charlotin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326506932 PECOS PAC ID: 5698108819 Enrollment ID: I20191202002324 |
| Provider Name | Dana M Hill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699248260 PECOS PAC ID: 3971836529 Enrollment ID: I20191202002607 |
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