Provider Demographics
NPI:1518260256
Name:SOUTHERN MEDICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:SOUTHERN MEDICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:LATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:YEDLAPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-843-4624
Mailing Address - Street 1:3520 PRESTON RD STE 108
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-9488
Mailing Address - Country:US
Mailing Address - Phone:214-436-4949
Mailing Address - Fax:214-436-5792
Practice Address - Street 1:3520 PRESTON RD STE 108
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-9488
Practice Address - Country:US
Practice Address - Phone:214-436-4949
Practice Address - Fax:214-436-5792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB148157Medicare PIN