Organization
SOUTHERN FAMILY MEDICAL CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE HODNICK (PRACTICE MANAGER)
(706) 560-2273
Entity
Organization
Contact information
Practice address
3736 MIKE PADGETT HWY STE A, AUGUSTA, GA 30906-0720
(706) 560-2273
(706) 560-0903
Mailing address
3736 MIKE PADGETT HWY STE A, AUGUSTA, GA 30906-0720
(706) 560-2273
(706) 560-0903
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GRPGPA904
—
SC
Enumeration date
11/10/2006
Last updated
12/07/2012
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