Provider Demographics
NPI:1962991703
Name:SOUTHERN HEALTHCARE ALLIANCE, LLC
Entity type:Organization
Organization Name:SOUTHERN HEALTHCARE ALLIANCE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:SWADER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-262-1981
Mailing Address - Street 1:101-F W. NORTHSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602
Mailing Address - Country:US
Mailing Address - Phone:229-262-1981
Mailing Address - Fax:229-375-0392
Practice Address - Street 1:101-F W. NORTHSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602
Practice Address - Country:US
Practice Address - Phone:229-262-1981
Practice Address - Fax:229-375-0392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003208546CMedicaid
GA003229819AMedicaid