# SOUTHERN HEALTHCARE PROVIDER GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southern Healthcare
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922273747
- **Authorized official:** NELSON MEDRANO (CLINIC DIRECTOR)
- **Authorized official phone:** (770) 792-7893

## Contact information

- **Practice address:** 2754 N DECATUR RD, SUITE 110, DECATUR, GA 30033-5917
- **Practice address phone:** (404) 838-0082
- **Mailing address:** PO BOX 6881, MARIETTA, GA 30065-0881

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111NR0400X | Rehabilitation Chiropractor | CHIRO07897 | GA | Yes |
| 208D00000X | General Practice Physician | 021447 | GA | — |

## Other

- **Enumeration date:** 04/23/2008
- **Last updated:** 04/23/2008