Provider Demographics
NPI:1962683961
Name:SOUTHERN HEALTH CORP OF ELLIJAY
Entity Type:Organization
Organization Name:SOUTHERN HEALTH CORP OF ELLIJAY
Other - Org Name:CRAIG FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MISS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SELF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-276-4741
Mailing Address - Street 1:PO BOX 1019
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-0013
Mailing Address - Country:US
Mailing Address - Phone:706-635-5177
Mailing Address - Fax:706-635-5183
Practice Address - Street 1:61 HIGHLAND CT
Practice Address - Street 2:SUITE 101
Practice Address - City:EAST ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-6777
Practice Address - Country:US
Practice Address - Phone:706-698-4362
Practice Address - Fax:706-698-4366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty