Provider Demographics
NPI:1811765142
Name:SOUTHEASTERN RHEUMATOLOGY ALLIANCE
Entity type:Organization
Organization Name:SOUTHEASTERN RHEUMATOLOGY ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-531-3711
Mailing Address - Street 1:961 SMOKY MTN SPGS LN NE STE A
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2418
Mailing Address - Country:US
Mailing Address - Phone:770-531-3711
Mailing Address - Fax:
Practice Address - Street 1:1715 RESURGENCE DRIVE
Practice Address - Street 2:SUITE 210
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677
Practice Address - Country:US
Practice Address - Phone:770-531-3711
Practice Address - Fax:770-531-3718
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHEASTERN RHEUMATOLOGY ALLIANCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty