Provider Demographics
NPI:1962652537
Name:SOUTHLAND MEDICAL SOLUTIONS OF ANDALUSIA PL
Entity Type:Organization
Organization Name:SOUTHLAND MEDICAL SOLUTIONS OF ANDALUSIA PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-907-2586
Mailing Address - Street 1:7004 NW 52ND TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-7008
Mailing Address - Country:US
Mailing Address - Phone:205-907-2586
Mailing Address - Fax:
Practice Address - Street 1:849 S THREE NOTCH ST
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-5325
Practice Address - Country:US
Practice Address - Phone:334-222-8466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty