Organization
SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE, INC.
Active
Other names
Southern Crescent Hospital for Specialty Care
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER KARAM (PRESIDENT & CEO)
(713) 277-2771
Entity
Organization
Contact information
Practice address
11 UPPER RIVERDALE RD SW, 6TH FLOOR, RIVERDALE, GA 30274-2615
(770) 897-7603
(770) 897-7606
Mailing address
11 UPPER RIVERDALE RD SW, 6TH FLOOR, RIVERDALE, GA 30274-2615
(770) 897-7603
(770) 897-7606
Taxonomy
Speciality
Code
Description
License number
State
282E00000X
Long Term Care Hospital
Primary
031-614
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003109426A
—
GA
01
—
3397399
AETNA PVN
GA
01
—
7361505
AETNA PIN
GA
Enumeration date
10/10/2006
Last updated
08/03/2011
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