Provider Demographics
NPI:1760838395
Name:SOUTHLAND BAINBRIDGE HOSPITALIST GROUP, LLC
Entity Type:Organization
Organization Name:SOUTHLAND BAINBRIDGE HOSPITALIST GROUP, LLC
Other - Org Name:SOUTHLAND MITCHELL HOSPITALIST GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:229-520-7115
Mailing Address - Street 1:PO BOX 1276
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31799-1276
Mailing Address - Country:US
Mailing Address - Phone:229-520-7115
Mailing Address - Fax:
Practice Address - Street 1:90 E STEPHENS ST
Practice Address - Street 2:
Practice Address - City:CAMILLA
Practice Address - State:GA
Practice Address - Zip Code:31730-1836
Practice Address - Country:US
Practice Address - Phone:229-336-5284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty