Organization
SOUTHERN HEALTHCARE PROVIDER GROUP, LLC
Active
Other names
Southern Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
NELSON MEDRANO (CLINIC DIRECTOR)
(770) 792-7893
Entity
Organization
Contact information
Practice address
2754 N DECATUR RD, SUITE 110, DECATUR, GA 30033-5917
(404) 838-0082
Mailing address
PO BOX 6881, MARIETTA, GA 30065-0881
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
CHIRO07897
GA
208D00000X
General Practice Physician
021447
GA
Other
Enumeration date
04/23/2008
Last updated
04/23/2008
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