Provider Demographics
NPI:1568433407
Name:SOUTHERLAND, JAMES E (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:SOUTHERLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:114 HARMONY XING STE 1
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-9546
Mailing Address - Country:US
Mailing Address - Phone:706-484-0884
Mailing Address - Fax:706-484-0885
Practice Address - Street 1:114 HARMONY XING STE 1
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-9546
Practice Address - Country:US
Practice Address - Phone:706-484-0884
Practice Address - Fax:706-484-0885
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA024632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA024632OtherLICENSE NUMBER
GAD30871Medicare UPIN
GA000956238AMedicare ID - Type Unspecified
GA111869Medicare ID - Type Unspecified