Organization
SOUTHEASTERN WOUND CARE SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SID M SHAH M.D. (PRESIDENT)
(404) 444-1293
Entity
Organization
Contact information
Practice address
1412 MILSTEAD AVE NE, ROCKDALE MEDICAL CENTER, CONYERS, GA 30012-3877
(678) 413-7738
(678) 413-7739
Mailing address
1805 GALILEE CT, TUCKER, GA 30084-7405
(404) 444-1293
(404) 601-6880
Taxonomy
Speciality
Code
Description
License number
State
207PE0005X
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
Primary
59757
GA
Other
Enumeration date
10/05/2007
Last updated
09/18/2009
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