Organization
PREMIER SOUTH MEDICAL GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REANNA RAMKHELAWAN (CONTRACTING SPECIALIST)
(786) 281-2398
Entity
Organization
Contact information
Practice address
770 GREISON TRL, SUITE F, NEWNAN, GA 30263-6408
(770) 251-4120
(770) 251-4575
Mailing address
8750 NW 36TH ST, SUITE 300, DORAL, FL 33178-2425
(786) 641-5348
(305) 615-1121
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003182726A
—
GA
Enumeration date
12/12/2016
Last updated
12/19/2016
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