Provider Demographics
NPI:1487800199
Name:MEDICAL SERVICES OF SOUTHERN GEORGIA, INC.
Entity type:Organization
Organization Name:MEDICAL SERVICES OF SOUTHERN GEORGIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-598-5519
Mailing Address - Street 1:3522 ASFORD DUNWOODY ROAD SUITE #407
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-4207
Mailing Address - Country:US
Mailing Address - Phone:678-598-5519
Mailing Address - Fax:
Practice Address - Street 1:3522 ASFORD DUNWOODY ROAD SUITE #407
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30319-4207
Practice Address - Country:US
Practice Address - Phone:678-598-5519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty