Provider Demographics
NPI:1578864187
Name:GEORGE A SOUTHIERE JR MD, PC
Entity Type:Organization
Organization Name:GEORGE A SOUTHIERE JR MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ARMAND
Authorized Official - Last Name:SOUTHIERE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:401-258-4535
Mailing Address - Street 1:600 PUTNAM PIKE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:GREENVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02828-1486
Mailing Address - Country:US
Mailing Address - Phone:401-258-4535
Mailing Address - Fax:
Practice Address - Street 1:600 PUTNAM PIKE
Practice Address - Street 2:SUITE 7
Practice Address - City:GREENVILLE
Practice Address - State:RI
Practice Address - Zip Code:02828-1486
Practice Address - Country:US
Practice Address - Phone:401-258-4535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD09907207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty