Organization
SOUTHERN CRESCENT PHYSICIANS GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN MCLAIN (COO)
(770) 897-7546
Entity
Organization
Contact information
Practice address
11 UPPER RIVERDALE RD SW, TERRACE LEVEL, RIVERDALE, GA 30274-2615
(770) 996-3190
(770) 996-3529
Mailing address
11 UPPER RIVERDALE RD SW, RIVERDALE, GA 30274-2615
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
053450
GA
2084N0400X
Neurology Physician
Primary
028352
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
990103456A
—
GA
Enumeration date
10/28/2014
Last updated
06/22/2015
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