Provider Demographics
NPI:1114146677
Name:SOUTHERN HOSPITAL PHYSICIANS,LLC
Entity type:Organization
Organization Name:SOUTHERN HOSPITAL PHYSICIANS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-313-0515
Mailing Address - Street 1:PO BOX 54424
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-0424
Mailing Address - Country:US
Mailing Address - Phone:770-458-1594
Mailing Address - Fax:770-458-1596
Practice Address - Street 1:135 BLACKLAND CT E
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067
Practice Address - Country:US
Practice Address - Phone:404-313-0515
Practice Address - Fax:678-540-5473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047899207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000842916GMedicaid
GAH06794Medicare UPIN
GA000842916GMedicaid