Organization
MEDSOUTH ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD WRIGHT (OFFICE MANAGER)
(770) 996-9400
Entity
Organization
Contact information
Practice address
483 UPPER RIVERDALE RD SW STE G, RIVERDALE, GA 30274-2584
(770) 996-9400
(770) 991-2918
Mailing address
483 UPPER RIVERDALE RD SW STE G, RIVERDALE, GA 30274-2584
(770) 996-9400
(770) 991-2918
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
022956
GA
207R00000X
Internal Medicine Physician
036647
GA
207R00000X
Internal Medicine Physician
046927
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000252238A
—
GA
05
—
000892581F
—
GA
05
—
000897949A
—
GA
01
—
003004
BC
—
01
—
149377
BC
—
01
—
855141
BC
—
Enumeration date
08/06/2007
Last updated
03/12/2020
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