Provider Demographics
NPI:1215396577
Name:SOUTHERN MEDICAL CONSULTANTS LLC
Entity type:Organization
Organization Name:SOUTHERN MEDICAL CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-927-9355
Mailing Address - Street 1:7048 OLD CANTON RD STE 2E
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1021
Mailing Address - Country:US
Mailing Address - Phone:601-992-9790
Mailing Address - Fax:601-992-9796
Practice Address - Street 1:7048 OLD CANTON RD STE 2E
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1021
Practice Address - Country:US
Practice Address - Phone:601-992-9790
Practice Address - Fax:601-992-9796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR733261363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty