| Southern Hospital Physicians,llc | |
|
135 Blackland Ct E Marietta GA 30067 | |
| (404) 313-0515 | |
| (678) 540-5473 |
| Full Name | Southern Hospital Physicians,llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 135 Blackland Ct E, Marietta, Georgia |
| Authorized Official Name and Position | Kenneth R. Warner (MANAGER) |
| Authorized Official Contact | 4043130515 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Hospital Physicians,llc Po Box 54424 Atlanta GA 30308-0424 Ph: (770) 458-1594 | Southern Hospital Physicians,llc 135 Blackland Ct E Marietta GA 30067 Ph: (404) 313-0515 |
| NPI Number | 1114146677 |
|---|---|
| Provider Enumeration Date | 04/24/2007 |
| Last Update Date | 08/05/2025 |
| Medicare PECOS PAC ID | 9335037134 |
|---|---|
| Medicare Enrollment ID | O20040304000831 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114146677 | NPI | - | NPPES |
| 000842916G | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 047899 (Georgia) | Primary |
| Provider Name | Shannon K Fields |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518031707 PECOS PAC ID: 9931097730 Enrollment ID: I20040305000297 |
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