Organization
SOUTHERN REGIONAL MEDICAL CENTER INC
Active
Other names
Home Health
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD STOVALL (CHIEF FINANCIAL OFFICER)
(770) 991-8165
Entity
Organization
Contact information
Practice address
224 E COLLEGE ST, GRIFFIN, GA 30224-4348
(770) 991-8662
(770) 991-8663
Mailing address
11 UPPER RIVERDALE RD SW, BUILDING 25, RIVERDALE, GA 30274-2615
(770) 991-8662
(770) 991-8663
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00770272A
—
GA
Enumeration date
02/20/2007
Last updated
04/09/2008
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