# PREMIER SOUTH MEDICAL GROUP PC

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

## Provider details

- **NPI number:** 1669916573
- **Authorized official:** REANNA RAMKHELAWAN (CONTRACTING SPECIALIST)
- **Authorized official phone:** (786) 281-2398

## Contact information

- **Practice address:** 770 GREISON TRL, SUITE F, NEWNAN, GA 30263-6408
- **Practice address phone:** (770) 251-4120
- **Practice address fax:** (770) 251-4575
- **Mailing address:** 8750 NW 36TH ST, SUITE 300, DORAL, FL 33178-2425
- **Mailing address phone:** (786) 641-5348
- **Mailing address fax:** (305) 615-1121

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/12/2016
- **Last updated:** 12/19/2016