Organization
SOUTHERN GRACE HEALTHCARE
Active
Organization
SOUTHERN GRACE HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUBREY KEKIWI (CEO)
(678) 432-8811
Entity
Organization
Contact information
Practice address
364 RACETRACK RD, MCDONOUGH, GA 30252-1022
(678) 432-8811
(678) 432-8821
Mailing address
364 RACETRACK RD, MCDONOUGH, GA 30252-1022
(678) 432-8811
(678) 432-8821
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
64068
GA
253Z00000X
In Home Supportive Care Agency
—
—
Other
Enumeration date
01/13/2015
Last updated
01/13/2015
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