# SOUTHERN CRESCENT MEDICAL CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578111910
- **Authorized official:** SHANTEL BRYANT (OWNER)
- **Authorized official phone:** (770) 629-4374

## Contact information

- **Practice address:** 3579 HIGHWAY 138 SE STE 103, STOCKBRIDGE, GA 30281-4127
- **Practice address phone:** (770) 629-4374
- **Practice address fax:** (678) 545-1735
- **Mailing address:** 3579 HIGHWAY 138 SE STE 103, STOCKBRIDGE, GA 30281-4127
- **Mailing address phone:** (770) 629-4374
- **Mailing address fax:** (678) 545-1735

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 291U00000X | Clinical Medical Laboratory | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 08/29/2019
- **Last updated:** 09/08/2026