Southern Crescent Physicians Group, INC.
Psychiatry & Neurology, Neurology in Riverdale, GA. Organization (NPI-2).
NPI number1275932998
StatusActive
Last updated in NPPESAug 19, 2014
Details
- NPI
- 1275932998
- Entity type
- Organization (NPI-2)
- Legal business name
- Southern Crescent Physicians Group, INC.
- Organization subpart
- No
- Enumeration date
- Aug 19, 2014
- Last updated
- Aug 19, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology, Neurology | 053450 | GA | Yes |
Practice location
33 Upper Riverdale Rd SwSuite 112
Riverdale, GA 30274-2626
Phone 770-897-7056 · Fax 770-909-2169
Mailing address
11 Upper Riverdale Rd SwRiverdale, GA 30274-2615
Phone 770-897-7056
Authorized official
John Mcclain
Ceo
7708977056
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