| Southern Healthcare Provider Group, Llc | |
|
2754 N Decatur Rd Suite 110 Decatur GA 30033-5917 | |
| (404) 838-0082 | |
| Not Available |
| Full Name | Southern Healthcare Provider Group, Llc |
|---|---|
| Speciality | Chiropractor - Rehabilitation |
| Location | 2754 N Decatur Rd, Decatur, Georgia |
| Authorized Official Name and Position | Nelson Medrano (CLINIC DIRECTOR) |
| Authorized Official Contact | 7707927893 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Healthcare Provider Group, Llc Po Box 6881 Marietta GA 30065-0881 Ph: () - | Southern Healthcare Provider Group, Llc 2754 N Decatur Rd Suite 110 Decatur GA 30033-5917 Ph: (404) 838-0082 |
| NPI Number | 1922273747 |
|---|---|
| Provider Enumeration Date | 04/23/2008 |
| Last Update Date | 04/23/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922273747 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 021447 (Georgia) | Secondary |
| 111NR0400X | Chiropractor - Rehabilitation | CHIRO07897 (Georgia) | Primary |
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