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Organization
SOUTHERN PHYSICIAN GROUP MANAGEMENT LLC
Active
Organization
SOUTHERN PHYSICIAN GROUP MANAGEMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRANT DOUGLASS (PRESIDENT)
(361) 729-0646
Entity
Organization
Contact information
Practice address
1204 N MOUND ST, NACOGDOCHES, TX 75961-4027
(936) 564-4611
Mailing address
PO BOX 200039, DALLAS, TX 75320-0039
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
04/07/2021
Last updated
07/26/2022
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