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General NPI Number Information
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NPI Number | 1093901480
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Entity Type | Organization
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Legal Business Name | SOUTHERN MEDICAL CORPORATION PC
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 12/07/2015
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Provider Practice Location Address
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Address Line | 6433 E WASHINGTON ST SUITE 125
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-6677
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Country | US
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Telephone | 317-923-1274
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Fax | 317-924-4436
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Provider Business Mailing Address
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Address Line | 6433 E WASHINGTON ST SUITE 125
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-6677
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Country | US
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Telephone | 317-923-1274
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Fax | 317-924-4436
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CHERYLE DAWN SOUTHERN
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Credential | M.D.
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Telephone | 317-923-1274
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01033547A
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License Number State | IN
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