Provider Demographics
NPI:1710870944
Name:SOUTHERN ROOTS DPC LLC
Entity type:Organization
Organization Name:SOUTHERN ROOTS DPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER AND PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMMER
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:229-300-3642
Mailing Address - Street 1:6888 MCNEAL RD
Mailing Address - Street 2:
Mailing Address - City:HAHIRA
Mailing Address - State:GA
Mailing Address - Zip Code:31632-2029
Mailing Address - Country:US
Mailing Address - Phone:229-300-3642
Mailing Address - Fax:
Practice Address - Street 1:407 N PARRISH AVE
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:GA
Practice Address - Zip Code:31620-2076
Practice Address - Country:US
Practice Address - Phone:229-300-3642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-28
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty