Organization
PRIME HEALTHCARE FOUNDATION - SOUTHERN REGIONAL, LLC
Active
Organization
PRIME HEALTHCARE FOUNDATION - SOUTHERN REGIONAL, LLC
Active
Parent organization
PRIME HEALTHCARE FOUNDATION - SOUTHERN REGIONAL, LLC
Other names
Southern Regional Medical Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
PRIME HEALTHCARE FOUNDATION - SOUTHERN REGIONAL, LLC
Authorized official
CHRISTOPHER DOAN (COMPLIANCE OFFICER)
(310) 259-4706
Entity
Organization
Contact information
Practice address
11 UPPER RIVERDALE RD SW, RIVERDALE, GA 30274-2615
(770) 991-8160
(770) 909-2595
Mailing address
11 UPPER RIVERDALE RD SW, RIVERDALE, GA 30274-2615
(770) 991-8160
(770) 909-2595
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
Primary
031-710
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000404A
—
GA
Enumeration date
09/10/2018
Last updated
09/10/2018
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up