Basic Information
| Provider Information | |||||||||
| NPI: | 1679709125 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHLAND MEDICAL SOLUTIONS OF BERRIEN, PLLC | ||||||||
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| Address1: | PO BOX 5218 | ||||||||
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| City: | NICEVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325785218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508977244 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1221 E MCPHERSON AVE | ||||||||
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| City: | NASHVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 316392326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2295437100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2009 | ||||||||
| LastUpdateDate: | 09/07/2022 | ||||||||
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| AuthorizedOfficialLastName: | HART | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8508977244 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 09/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.