| Southern Hospital Physicians,llc | |
|
550 Peachtree St Ne Atlanta GA 30308-2247 | |
| (770) 458-1594 | |
| Not Available |
| Full Name | Southern Hospital Physicians,llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 550 Peachtree St Ne, Atlanta, Georgia |
| Authorized Official Name and Position | Ken R. Warner (ADMINISTRATOR) |
| Authorized Official Contact | 7704581594 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Hospital Physicians,llc Po Box 54424 Atlanta GA 30308-0424 Ph: (770) 458-1594 | Southern Hospital Physicians,llc 550 Peachtree St Ne Atlanta GA 30308-2247 Ph: (770) 458-1594 |
| NPI Number | 1114146677 |
|---|---|
| Provider Enumeration Date | 04/24/2007 |
| Last Update Date | 09/07/2012 |
| Medicare PECOS PAC ID | 9335037134 |
|---|---|
| Medicare Enrollment ID | O20040304000831 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114146677 | NPI | - | NPPES |
| 000842916G | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 047899 (Georgia) | Primary |
| Provider Name | Shannon K Fields |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518031707 PECOS PAC ID: 9931097730 Enrollment ID: I20040305000297 |
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