Provider Demographics
NPI:1700378965
Name:SOUTHERN MEDICAL SOLUTIONS
Entity Type:Organization
Organization Name:SOUTHERN MEDICAL SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-C
Authorized Official - Prefix:MRS
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:ELYSE
Authorized Official - Last Name:MOWDY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:601-730-0602
Mailing Address - Street 1:186 BURRIS RD SE
Mailing Address - Street 2:
Mailing Address - City:MC CALL CREEK
Mailing Address - State:MS
Mailing Address - Zip Code:39647-5295
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:186 BURRIS RD SE
Practice Address - Street 2:
Practice Address - City:MC CALL CREEK
Practice Address - State:MS
Practice Address - Zip Code:39647-5295
Practice Address - Country:US
Practice Address - Phone:601-730-0602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care