Southlake Health Care

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

SOUTHLAKE HEALTH CARE

Practice address

1096 Mount Zion Rd Ste 1130
Morrow, GA 30260-2213

Phone

(678) 604-7739

Fax

(470) 615-7772

NPI assigned

Dec 9, 2019

Last updated

Dec 9, 2019By 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

Justin James Broe, DC

Title

Proprietor

Phone

(404) 884-0298

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1575849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575849600000",
    "number": "1235776220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1096 MOUNT ZION RD STE 1130",
            "city": "MORROW",
            "state": "GA",
            "postal_code": "302602213",
            "telephone_number": "678-604-7739",
            "fax_number": "470-615-7772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1096 MOUNT ZION RD STE 1130",
            "city": "MORROW",
            "state": "GA",
            "postal_code": "302602213",
            "telephone_number": "678-604-7739",
            "fax_number": "470-615-7772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAKE HEALTH CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-09",
        "last_updated": "2019-12-09",
        "certification_date": "2019-12-09",
        "status": "A",
        "authorized_official_last_name": "BROE",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "PROPRIETOR",
        "authorized_official_telephone_number": "404-884-0298",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Morrow, GA
• Providers in Morrow, GA by specialty
• Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2019; 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.