Basic Information
| Provider Information | |||||||||
| NPI: | 1467960146 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHLAND EVANS HOSPITALIST GROUP LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 S MADISON ST | ||||||||
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| City: | THOMASVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317925473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2292360831 | ||||||||
| FaxNumber: | 2292360871 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 N RIVER ST | ||||||||
| Address2: | |||||||||
| City: | CLAXTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 304171659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9127395000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2018 | ||||||||
| LastUpdateDate: | 06/16/2018 | ||||||||
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| AuthorizedOfficialLastName: | FLETCHER | ||||||||
| AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2292360831 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.