Provider Demographics
NPI:1568516151
Name:SOUTHERN ORTHOPAEDIC SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:SOUTHERN ORTHOPAEDIC SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-397-2663
Mailing Address - Street 1:516 BROOKWOOD BLVD
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6802
Mailing Address - Country:US
Mailing Address - Phone:205-397-2663
Mailing Address - Fax:205-278-0049
Practice Address - Street 1:516 BROOKWOOD BLVD
Practice Address - Street 2:FLOOR 2
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6802
Practice Address - Country:US
Practice Address - Phone:205-397-2663
Practice Address - Fax:205-278-0049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22420207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529910970Medicaid
ALI662Medicare UPIN