Provider Demographics
NPI:1639491459
Name:SOUTHCARE OF DOUGLAS, INC
Entity Type:Organization
Organization Name:SOUTHCARE OF DOUGLAS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ECHEBELEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-552-4361
Mailing Address - Street 1:208 PETERSON AVE S
Mailing Address - Street 2:SUITE 203
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-5239
Mailing Address - Country:US
Mailing Address - Phone:404-552-4361
Mailing Address - Fax:229-888-3558
Practice Address - Street 1:208 PETERSON AVE S
Practice Address - Street 2:SUITE 203
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-5239
Practice Address - Country:US
Practice Address - Phone:404-552-4361
Practice Address - Fax:229-888-3558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-21
Last Update Date:2010-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034-R-0641251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health