Provider Demographics
NPI:1154370104
Name:SOUTHERN SURGICAL ASSOCIATES, PA
Entity type:Organization
Organization Name:SOUTHERN SURGICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZIRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-758-2224
Mailing Address - Street 1:2455 EMERALD PL
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5785
Mailing Address - Country:US
Mailing Address - Phone:252-758-2224
Mailing Address - Fax:252-758-2860
Practice Address - Street 1:2455 EMERALD PL
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5785
Practice Address - Country:US
Practice Address - Phone:252-758-2224
Practice Address - Fax:252-758-2860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901798Medicaid
NC017EXOtherBCBS
NC2347684Medicare ID - Type UnspecifiedMEDICARE NUMBER