Southern Crescent Physicians Group, INC.
Psychiatry & Neurology, Neurology in Riverdale, GA. Organization (NPI-2).
NPI number1588069900
StatusActive
Last updated in NPPESJun 22, 2015
Details
- NPI
- 1588069900
- Entity type
- Organization (NPI-2)
- Legal business name
- Southern Crescent Physicians Group, INC.
- Organization subpart
- No
- Enumeration date
- Oct 28, 2014
- Last updated
- Jun 22, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology, Neurology | 028352 | GA | Yes |
| 207T00000X | Neurological Surgery | 053450 | GA |
Practice location
11 Upper Riverdale Rd SwTerrace Level
Riverdale, GA 30274-2615
Phone 770-996-3190 · Fax 770-996-3529
Mailing address
11 Upper Riverdale Rd SwRiverdale, GA 30274-2615
Authorized official
John Mclain
Coo
7708977546
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