Healthcare Provider Details

I. General information

NPI: 1437338886
Provider Name (Legal Business Name): SURGERY SOUTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

985 9TH AVE SW STE 507
BESSEMER AL
35022-7814
US

IV. Provider business mailing address

975 9TH AVE SW SUITE 200
BESSEMER AL
35022-7837
US

V. Phone/Fax

Practice location:
  • Phone: 205-481-7485
  • Fax: 205-481-7494
Mailing address:
  • Phone: 205-481-7485
  • Fax: 205-481-7494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number13626
License Number StateAL

VIII. Authorized Official

Name: MS. KATHERINE SHUNNARAH
Title or Position: OFFICE MANAGER
Credential:
Phone: 205-481-7485