Healthcare Provider Details

I. General information

NPI: 1811096480
Provider Name (Legal Business Name): SOUTHERN ENDOCRINOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 IH-30 BUIDLING D SUITE 203
MESQUITE TX
75150
US

IV. Provider business mailing address

3500 I-30 AT MOTLEY BUILDING D, SUITE # 203
MESQUITE TX
75150
US

V. Phone/Fax

Practice location:
  • Phone: 972-682-5700
  • Fax:
Mailing address:
  • Phone: 972-682-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberM4788
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberMA07612100
License Number StateNJ

VIII. Authorized Official

Name: DR. SUMANA GANGI
Title or Position: DIRECTOR
Credential: MD
Phone: 214-909-8904