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Organization
SOUTHERN HEALTHCARE PROVIDER GROUP, LLC
Active
Organization
SOUTHERN HEALTHCARE PROVIDER GROUP, LLC
Active
Other names
Southern Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
NELSON MEDRANO (CLINIC DIRECTOR)
(770) 792-7893
Entity
Organization
Contact information
Practice address
2754 N DECATUR RD, SUITE 110, DECATUR, GA 30033-5917
(404) 838-0082
Mailing address
PO BOX 6881, MARIETTA, GA 30065-0881
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
CHIRO07897
GA
208D00000X
General Practice Physician
021447
GA
Other
Enumeration date
04/23/2008
Last updated
04/23/2008
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