Healthcare Provider Details

I. General information

NPI: 1295940070
Provider Name (Legal Business Name): ANDREW SOUTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LOCUST ST STE 540
AKRON OH
44302-1809
US

IV. Provider business mailing address

300 LOCUST ST STE 540
AKRON OH
44302-1809
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-8348
  • Fax: 330-543-8356
Mailing address:
  • Phone: 330-543-8348
  • Fax: 330-543-8356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number200300888
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number35.091361
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: