Healthcare Provider Details

I. General information

NPI: 1407892938
Provider Name (Legal Business Name): SOUTHERN ORTHOPEDIC SPECIALISTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 HARRISON AVE
PANAMA CITY FL
32405-7605
US

IV. Provider business mailing address

1827 HARRISON AVE
PANAMA CITY FL
32405-7605
US

V. Phone/Fax

Practice location:
  • Phone: 850-785-4344
  • Fax: 850-785-6568
Mailing address:
  • Phone: 850-785-4344
  • Fax: 850-785-6568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DELFORD GREGGS JR.
Title or Position: CEO
Credential:
Phone: 850-785-4344