Provider Demographics
NPI:1790228773
Name:SOUTHERN CROSS HEALTH GROUP, LLC
Entity Type:Organization
Organization Name:SOUTHERN CROSS HEALTH GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUNKER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-BC, NP-C
Authorized Official - Phone:770-317-8244
Mailing Address - Street 1:980 BIRMINGHAM RD
Mailing Address - Street 2:STE 501-330
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-4417
Mailing Address - Country:US
Mailing Address - Phone:770-317-8244
Mailing Address - Fax:855-671-3535
Practice Address - Street 1:980 BIRMINGHAM RD
Practice Address - Street 2:STE 501-330
Practice Address - City:MILTON
Practice Address - State:GA
Practice Address - Zip Code:30004-4417
Practice Address - Country:US
Practice Address - Phone:770-317-8244
Practice Address - Fax:855-671-3535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN/FNP173575363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2025081570Medicare UPIN