Southern Crescent Medical Center, LLC
NPI 1578111910ActiveOrganization· Family Medicine· Stockbridge, GA
Family Medicine in Stockbridge, Georgia, registered in NPPES in August 2019. The authorized official on file is Shantel Bryant, Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1578111910 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Aug 29, 2019 |
| Last updated in NPPES | Sep 8, 2026 |
| Certified by provider | Sep 8, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Family Medicine Primary | 207Q00000X | — | — |
| Clinical Medical Laboratory | 291U00000X | — | — |
| Nurse Practitioner | 363L00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (GA) |
|---|
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