=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568516151
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHERN ORTHOPAEDIC SPECIALISTS, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2007
-----------------------------------------------------
Last Update Date | 01/22/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 516 BROOKWOOD BLVD FLOOR 2
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35209-6802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-397-2663
-----------------------------------------------------
Fax | 205-278-0049
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 516 BROOKWOOD BLVD FLOOR 2
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35209-6802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-397-2663
-----------------------------------------------------
Fax | 205-278-0049
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GREGG KEVIN CARR
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 205-397-2663
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 22420
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------