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General NPI Number Information
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NPI Number | 1902376676
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Entity Type | Organization
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Legal Business Name | SOUTHERN STATE ELECTRIC & PLUMBING
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Dates
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Enumeration Date | 11/26/2018
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Last Update Date | 12/21/2018
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Provider Practice Location Address
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Address Line | 5205 STARKEY RD APT B
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City | ROANOKE
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State | VA
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Zip | 24018-9366
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Country | US
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Telephone | 540-343-4348
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Fax | 540-772-2549
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Provider Business Mailing Address
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Address Line | 5205 STARKEY RD APT B
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City | ROANOKE
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State | VA
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Zip | 24018-9366
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Country | US
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Telephone | 540-343-4348
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Fax | 540-772-2549
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Authorized Official
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Title or Position | PROJECT COORDINAROR
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Name | MISS ASHLEE MARIE SIMMONS
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Credential |
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Telephone | 540-343-4348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number |
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License Number State |
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