Organization
SOUTHERN CRESCENT MEDICAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANTEL BRYANT (OWNER)
(770) 629-4374
Entity
Organization
Contact information
Practice address
3579 HIGHWAY 138 SE STE 103, STOCKBRIDGE, GA 30281-4127
(770) 629-4374
(678) 545-1735
Mailing address
3579 HIGHWAY 138 SE STE 103, STOCKBRIDGE, GA 30281-4127
(770) 629-4374
(678) 545-1735
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
291U00000X
Clinical Medical Laboratory
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003227501A
—
GA
Enumeration date
08/29/2019
Last updated
08/13/2025
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