Healthcare Provider Details

I. General information

NPI: 1184647323
Provider Name (Legal Business Name): SOUTHERN ORTHOPEDIC & SPORTS MEDICINE ASSOC P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 HIGHWAY 78 E
JASPER AL
35501-8903
US

IV. Provider business mailing address

PO BOX 580
JASPER AL
35502-0580
US

V. Phone/Fax

Practice location:
  • Phone: 205-221-5374
  • Fax: 205-384-1453
Mailing address:
  • Phone: 205-221-5374
  • Fax: 205-384-1453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: SHERRIE T. PIKE I
Title or Position: BUSINESS MANAGER
Credential:
Phone: 205-221-5374