Provider Demographics
NPI:1609964600
Name:SOUTHERN SURGICAL ASSOCIATES, P. A.
Entity Type:Organization
Organization Name:SOUTHERN SURGICAL ASSOCIATES, P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:AZAR
Authorized Official - Suffix:III
Authorized Official - Credentials:M D
Authorized Official - Phone:601-450-2401
Mailing Address - Street 1:39 FRANKLIN RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1588
Mailing Address - Country:US
Mailing Address - Phone:601-450-2401
Mailing Address - Fax:601-450-2434
Practice Address - Street 1:39 FRANKLIN RD
Practice Address - Street 2:SUITE 220
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1588
Practice Address - Country:US
Practice Address - Phone:601-450-2401
Practice Address - Fax:601-450-2434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15260174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118119Medicaid
MS00118119Medicaid