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NPI Code Detail

MEDICARE: SOUTHERN MEDICAL ASSOCIATES, P.A.

MEDICARE: SOUTHERN MEDICAL ASSOCIATES, P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianSC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043302060
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHERN MEDICAL ASSOCIATES, P.A.
Provider Business Mailing Address
First Line : 3418 CASEY ST
Second Line :
City : LORIS
State : SC
Zip : 29569-2904
Country : US
Telephone Number : 843-756-7885
Fax Number : 843-756-7855
Provider Business Practice Location Address
First Line : 3418 CASEY ST
Second Line :
City : LORIS
State : SC
Zip : 29569-2904
Country : US
Telephone Number : 843-756-7885
Fax Number : 843-756-7855
Authorized Official
Title or Position : PRACTICE MANAGER
Name : SUSAN M. JOHNSON
Credential :
Telephone Number : 843-756-7885
Provider Enumeration Date : 09/28/2006
Last Update Date : 08/22/2020

Similar Medicare Providers

1841285483 — SARAH J. NORRIS FNP
Practice Location Address:
3418 CASEY ST
LORIS, SC
29569-2904
Practice Phone: 843-756-7885
Practice Fax: 843-756-7855
1588760904 — KAREN L. STAPLES FNP
Practice Location Address:
3418 CASEY ST
LORIS, SC
29569-2904
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1710078282 — KEITH G HARKINS M.D.
Practice Location Address:
3418 CASEY ST
LORIS, SC
29569-2904
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Practice Fax: 843-756-7855
1467781005 — LORIS COMMUNITY HOSPITAL DISTRICT
Practice Location Address:
3418 CASEY ST
LORIS, SC
29569-2904
Practice Phone: 843-756-7885
Practice Fax: 843-756-7855
1215235064 — LORIS COMMUNITY HOSPITAL DISTRICT
Practice Location Address:
3418 CASEY ST
LORIS, SC
29569-2904
Practice Phone: 843-716-7911
Practice Fax: 843-716-7918
1003183120 — MCLEOD PHYSICIAN ASSOCIATES II
Practice Location Address:
3418 CASEY ST
LORIS, SC
29569-2904
Practice Phone: 843-756-7885
Practice Fax: 843-756-7855

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