Southern Crescent Physicians Group, Inc.

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

028352 Issued in GA

Legal business name

SOUTHERN CRESCENT PHYSICIANS GROUP, INC.

Practice address

11 Upper Riverdale Rd SW
Terrace Level
Riverdale, GA 30274-2615

Phone

(770) 996-3190

Fax

(770) 996-3529

NPI assigned

Oct 28, 2014

Organization subpart

No

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

Authorized official

Name

John McLain

Title

Coo

Phone

(770) 897-7546

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1414454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434931200000",
    "number": "1588069900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 UPPER RIVERDALE RD SW",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 UPPER RIVERDALE RD SW",
            "address_2": "TERRACE LEVEL",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742615",
            "telephone_number": "770-996-3190",
            "fax_number": "770-996-3529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CRESCENT PHYSICIANS GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-28",
        "last_updated": "2015-06-22",
        "status": "A",
        "authorized_official_last_name": "MCLAIN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "770-897-7546"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neurological Surgery",
            "state": "GA",
            "license": "053450",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "GA",
            "license": "028352",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "990103456A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southern Crescent Physicians Group
• Southern Crescent Physicians Group, Inc
• Southern Crescent Physicians Group, Inc.
• Southern Crescent Physicians Group, Inc.
• Southern Crescent Physicians Group, Inc.
• Southern Crescent Radiation Oncology Center LLC
• Southern Heart Specialists, P.C.
• Southern Medical Products, Inc.
• Southern Pulmonary Care
• Southern Regional Accident & Injury Inc.

• Neurology Physician in Riverdale, GA
• Providers in Riverdale, GA by specialty
• Neurology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 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.