Provider Demographics
NPI:1578113940
Name:SOUTHERN MEDICINE OF BAXLEY, INC
Entity Type:Organization
Organization Name:SOUTHERN MEDICINE OF BAXLEY, INC
Other - Org Name:SOUTHERN MEDICINE OF BAXLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMPLOYEES
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUSEY
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:912-785-7022
Mailing Address - Street 1:275 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31513-0516
Mailing Address - Country:US
Mailing Address - Phone:912-785-7022
Mailing Address - Fax:
Practice Address - Street 1:275 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513
Practice Address - Country:US
Practice Address - Phone:407-403-2228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-17
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care