Provider Demographics
NPI:1124022017
Name:SOUTHER, STEPHEN K (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:K
Last Name:SOUTHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 NANTAHALA DRIVE
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:TN
Mailing Address - Zip Code:37882
Mailing Address - Country:US
Mailing Address - Phone:229-869-8898
Mailing Address - Fax:
Practice Address - Street 1:8033 RAY MEARS BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919
Practice Address - Country:US
Practice Address - Phone:865-545-4592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA44108174400000X
GA044108207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAA98710Medicare UPIN