Provider Demographics
NPI:1265863856
Name:SOUTHLAND NAHUNTA, LLC
Entity Type:Organization
Organization Name:SOUTHLAND NAHUNTA, LLC
Other - Org Name:SATILLA FAMILY CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:229-300-5869
Mailing Address - Street 1:13202 CLEVELAND ST W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NAHUNTA
Mailing Address - State:GA
Mailing Address - Zip Code:31553-2875
Mailing Address - Country:US
Mailing Address - Phone:229-300-5896
Mailing Address - Fax:229-269-4874
Practice Address - Street 1:13202 CLEVELAND ST W
Practice Address - Street 2:SUITE 200
Practice Address - City:NAHUNTA
Practice Address - State:GA
Practice Address - Zip Code:31553-2875
Practice Address - Country:US
Practice Address - Phone:229-300-5896
Practice Address - Fax:229-269-4874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA59237261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center