Southern Crescent Endoscopy Suite, PC

Primary specialty

Endoscopy Clinic/CenterTaxonomy code 261QE0800X

Legal business name

SOUTHERN CRESCENT ENDOSCOPY SUITE, PC

Practice address

150 N Park TRL Ste a
Stockbridge, GA 30281-7372

Phone

(770) 507-0909

Fax

(770) 907-8448

NPI assigned

Jun 21, 2006

Last updated

Jun 28, 2022By 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

Jung Whun Suh, MD

Title

Chief Medical Officer

Phone

(404) 888-7575

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Listed as

Southern Crescent Endoscopy Suite PCCCN 11C0001082

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Northside Hospital, Inc.

  dba Northside Hospital Cherokee 'A Wellness Place'

  • Durable Medical Equipment & Medical Supplies
  • Canton, GA
  • NPI 1770112021

  Member Of

  NPD member

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656374400000",
    "number": "1245276195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 PEACHTREE ST NE",
            "address_2": "SUITE 1600",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303082208",
            "telephone_number": "404-888-7575",
            "fax_number": "404-885-7777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 N PARK TRL STE A",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817372",
            "telephone_number": "770-507-0909",
            "fax_number": "770-907-8448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CRESCENT ENDOSCOPY SUITE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-21",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A",
        "authorized_official_last_name": "SUH",
        "authorized_official_first_name": "JUNG",
        "authorized_official_middle_name": "WHUN",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "404-888-7575",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QE0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Endoscopy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00779402A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• South Horizon Healthcare LLC
• South Metro Bone & Joint PC
• South Metro Rehab and Sports Medicine, LLC
• Southern Compassion Home Care LLC
• Southern Crescent Care,LLC (Home Helpers)
• Southern Crescent ENT, P.C.
• Southern Crescent Medical Center, LLC
• Southern Crescent Nephrology, PC
• Southern Crescent Pain Management LLC
• Southern Crescent Pediatrics PC

• Endoscopy Clinic/Center in Stockbridge, GA
• Providers in Stockbridge, GA by specialty
• Endoscopy Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.