Provider Demographics
NPI:1437540275
Name:SOUTHERN PRO READ, LLC
Entity Type:Organization
Organization Name:SOUTHERN PRO READ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-860-8827
Mailing Address - Street 1:14231 SEAWAY RD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4628
Mailing Address - Country:US
Mailing Address - Phone:228-860-8827
Mailing Address - Fax:228-207-2201
Practice Address - Street 1:14231 SEAWAY RD STE F9
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4648
Practice Address - Country:US
Practice Address - Phone:228-860-8827
Practice Address - Fax:228-207-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty