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General NPI Number Information
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NPI Number | 1790612323
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Entity Type | Organization
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Legal Business Name | SOUTHERN ORTHOCARE INC
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Dates
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Enumeration Date | 05/07/2026
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Last Update Date | 05/07/2026
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Provider Practice Location Address
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Address Line | 403 PRINCETON RD STE 1
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City | JOHNSON CITY
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State | TN
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Zip | 37601-2040
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Country | US
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Telephone | 423-430-9480
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Fax | 423-430-9480
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Provider Business Mailing Address
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Address Line | 403 PRINCETON RD STE 1
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City | JOHNSON CITY
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State | TN
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Zip | 37601-2040
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Country | US
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Telephone | 423-430-9480
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Fax | 423-430-9480
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | SHEENA E WILLIAMS
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Credential |
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Telephone | 423-307-1890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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