Provider Demographics
NPI:1235706961
Name:SOUTHERN, FRANKLIN DAVID (LMSW)
Entity Type:Individual
Prefix:
First Name:FRANKLIN
Middle Name:DAVID
Last Name:SOUTHERN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W ERLANGER ST
Mailing Address - Street 2:
Mailing Address - City:POPLARVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39470-3009
Mailing Address - Country:US
Mailing Address - Phone:601-746-5145
Mailing Address - Fax:844-348-9002
Practice Address - Street 1:110 W ERLANGER ST
Practice Address - Street 2:
Practice Address - City:POPLARVILLE
Practice Address - State:MS
Practice Address - Zip Code:39470-3009
Practice Address - Country:US
Practice Address - Phone:601-746-5145
Practice Address - Fax:844-348-9002
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM9765104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker