Basic Information
| Provider Information | |||||||||
| NPI: | 1760838395 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHLAND BAINBRIDGE HOSPITALIST GROUP, LLC | ||||||||
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| OtherOrganizationName: | SOUTHLAND MITCHELL HOSPITALIST GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1276 | ||||||||
| Address2: | |||||||||
| City: | THOMASVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317991276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2295207115 | ||||||||
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| Practice Location | |||||||||
| Address1: | 90 E STEPHENS ST | ||||||||
| Address2: | |||||||||
| City: | CAMILLA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317301836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2293365284 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2016 | ||||||||
| LastUpdateDate: | 05/12/2016 | ||||||||
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| AuthorizedOfficialLastName: | FLETCHER | ||||||||
| AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2295207115 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CPA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.