Provider Demographics
NPI:1043088495
Name:SOUTHEASTERN RHEUMATOLOGY ALLIANCE
Entity type:Organization
Organization Name:SOUTHEASTERN RHEUMATOLOGY ALLIANCE
Other - Org Name:<UNAVAIL>
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 1:700 S ENOTA DR NE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2403
Mailing Address - Country:US
Mailing Address - Phone:770-531-3711
Mailing Address - Fax:
Practice Address - Street 1:980 JOHNSON FY RD NE STE 220
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1623
Practice Address - Country:US
Practice Address - Phone:404-255-5956
Practice Address - Fax:404-255-3908
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHEASTERN RHEUMATOLOGY ALLIANCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-14
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing Site