MEDICARE: SOUTHERN NEUROSURGERY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician

General Provider Information

NPI Number	:	1730043217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN NEUROSURGERY LLC

Provider Business Mailing Address
First Line	:	601 BROAD ST SE STE A
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-3718
Country	:	US
Telephone Number	:	770-503-4446
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 BROAD ST SE STE A
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-3718
Country	:	US
Telephone Number	:	770-503-4446
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	BETSY HUGHES GRUNCH
Credential	:	MD
Telephone Number	:	770-503-4446

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/11/2025

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