Provider Demographics
NPI:1992915227
Name:SOUTHERN ORTHOPAEDICS
Entity type:Organization
Organization Name:SOUTHERN ORTHOPAEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-451-0200
Mailing Address - Street 1:541 W MONTGOMERY ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-3292
Mailing Address - Country:US
Mailing Address - Phone:478-451-0200
Mailing Address - Fax:478-451-0250
Practice Address - Street 1:541 W MONTGOMERY ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-3292
Practice Address - Country:US
Practice Address - Phone:478-451-0200
Practice Address - Fax:478-451-0250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA02854207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE75951Medicare UPIN
GA20NCCHRMedicare ID - Type Unspecified