Provider Demographics
NPI:1568477966
Name:SOUTHERN MEDICAL PRODUCTS, INC.
Entity Type:Organization
Organization Name:SOUTHERN MEDICAL PRODUCTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:EMBREE
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED PEDORTHIST
Authorized Official - Phone:770-991-0650
Mailing Address - Street 1:6518 HIGHWAY 85
Mailing Address - Street 2:SUITE D
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2364
Mailing Address - Country:US
Mailing Address - Phone:770-991-0650
Mailing Address - Fax:
Practice Address - Street 1:6518 HIGHWAY 85
Practice Address - Street 2:SUITE D
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2364
Practice Address - Country:US
Practice Address - Phone:770-991-0650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0135900001Medicare ID - Type Unspecified