Southern Grace Healthcare

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

64068 Issued in GA

Legal business name

SOUTHERN GRACE HEALTHCARE

Practice address

364 Racetrack Rd
McDonough, GA 30252-1022

Phone

(678) 432-8811

Fax

(678) 432-8821

NPI assigned

Jan 13, 2015

Last updated

Jan 13, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Aubrey Kekiwi

Title

Ceo

Phone

(678) 432-8811

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1421107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421107200000",
    "number": "1043609134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "364 RACETRACK RD",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302521022",
            "telephone_number": "678-432-8811",
            "fax_number": "678-432-8821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "364 RACETRACK RD",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302521022",
            "telephone_number": "678-432-8811",
            "fax_number": "678-432-8821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN GRACE HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-13",
        "last_updated": "2015-01-13",
        "status": "A",
        "authorized_official_last_name": "KEKIWI",
        "authorized_official_first_name": "AUBREY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-432-8811"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "64068",
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in McDonough, GA
• Providers in McDonough, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.