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Organization
PRIME HEALTHCARE FOUNDATION - SOUTHERN REGIONAL, LLC
Active
Organization
PRIME HEALTHCARE FOUNDATION - SOUTHERN REGIONAL, LLC
Active
Other names
Southern Regional Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER DOAN (MANAGING ASSOCIATE GENERAL COUNSEL)
(310) 259-4706
Entity
Organization
Contact information
Practice address
11 UPPER RIVERDALE RD SW, RIVERDALE, GA 30274-2615
(770) 991-8000
Mailing address
11 UPPER RIVERDALE RD SW, RIVERDALE, GA 30274-2615
(770) 991-8000
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
—
—
282N00000X
General Acute Care Hospital
Primary
031-442
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000404A
—
GA
Enumeration date
11/23/2015
Last updated
09/14/2021
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