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General NPI Number Information
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NPI Number | 1982884029
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Entity Type | Organization
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Legal Business Name | SOUTHERN BRACE & BILLING LLC
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Dates
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Enumeration Date | 11/06/2007
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Last Update Date | 11/06/2007
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Provider Practice Location Address
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Address Line | 1700 W GOVERNMENT ST BUILDING A SUITE C
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City | BRANDON
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State | MS
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Zip | 39042-2417
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Country | US
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Telephone | 601-906-9396
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 W GOVERNMENT ST BUILDING A SUITE C
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City | BRANDON
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State | MS
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Zip | 39042-2417
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Country | US
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Telephone | 601-906-9396
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ANTHONY DERRICK SCOGGINS
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Credential |
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Telephone | 601-906-9396
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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 | APPLIED FOR
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License Number State | MS
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