Provider Demographics
NPI:1477986107
Name:SOUTHERN EMERGENCY PHYSICIANS, LLP
Entity Type:Organization
Organization Name:SOUTHERN EMERGENCY PHYSICIANS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLP MANGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DERIK
Authorized Official - Middle Name:K
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-916-5259
Mailing Address - Street 1:75 REMIT DR
Mailing Address - Street 2:SUITE 1209
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-1209
Mailing Address - Country:US
Mailing Address - Phone:866-916-5259
Mailing Address - Fax:231-922-4030
Practice Address - Street 1:1077 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:GA
Practice Address - Zip Code:30650-2073
Practice Address - Country:US
Practice Address - Phone:866-916-5259
Practice Address - Fax:231-922-4030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty