Southern Health Care of Georgia

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

SOUTHERN HEALTH CARE OF GEORGIA

Practice address

2790 Sandy Plains Rd
Suite 202
Marietta, GA 30066-4373

Phone

(770) 509-5920

Fax

(770) 509-5922

NPI assigned

Aug 31, 2013

Last updated

Aug 31, 2013By 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

Mr. Jerry D Blackmon

Title

Owner

Phone

(770) 509-5920

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1377907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377907200000",
    "number": "1225462864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2790 SANDY PLAINS RD",
            "address_2": "SUITE 202",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300664373",
            "telephone_number": "770-509-5920",
            "fax_number": "770-509-5922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2790 SANDY PLAINS RD",
            "address_2": "SUITE 202",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300664373",
            "telephone_number": "770-509-5920",
            "fax_number": "770-509-5922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN HEALTH CARE OF GEORGIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-31",
        "last_updated": "2013-08-31",
        "status": "A",
        "authorized_official_last_name": "BLACKMON",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-509-5920",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Marietta, GA
• Providers in Marietta, GA by specialty
• Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2013; 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.