Provider Demographics
NPI:1528296936
Name:SOUTHERN NEUROLOGY, PA
Entity type:Organization
Organization Name:SOUTHERN NEUROLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:WATKINS
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:843-836-3667
Mailing Address - Street 1:23 PLANTATION PARK DRIVE
Mailing Address - Street 2:BLDG 400 BOX 402
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-9009
Mailing Address - Country:US
Mailing Address - Phone:843-836-3667
Mailing Address - Fax:843-836-3677
Practice Address - Street 1:23 PLANTATION PARK DR
Practice Address - Street 2:BLDG 400 BOX 402
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6038
Practice Address - Country:US
Practice Address - Phone:843-836-3667
Practice Address - Fax:843-836-3677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC145582084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty