Healthcare Provider Details

I. General information

NPI: 1467390013
Provider Name (Legal Business Name): SOUTHERN NEUROSURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 BROAD ST SE STE A
GAINESVILLE GA
30501-3718
US

IV. Provider business mailing address

601 BROAD ST SE STE A
GAINESVILLE GA
30501-3718
US

V. Phone/Fax

Practice location:
  • Phone: 470-293-9800
  • Fax: 844-689-4542
Mailing address:
  • Phone: 470-293-9800
  • Fax: 844-689-4542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL

VIII. Authorized Official

Name: BETSY H GRUNCH
Title or Position: MD/OWNER
Credential: MD
Phone: 470-293-9800