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General NPI Number Information
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NPI Number | 1437372661
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Entity Type | Organization
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Legal Business Name | WINDER MEDICAL PA
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 251 E BROAD ST
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City | WINDER
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State | GA
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Zip | 30680-2206
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Country | US
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Telephone | 770-867-9181
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Fax | 770-867-4817
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Provider Business Mailing Address
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Address Line | 251 E BROAD ST
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City | WINDER
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State | GA
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Zip | 30680-2206
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Country | US
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Telephone | 770-867-9181
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Fax | 770-867-4817
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOE C SOUTHER
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Credential | MD
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Telephone | 770-867-9181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 15425
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License Number State | GA
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