Provider Demographics
NPI:1972704732
Name:SOUTHERN, ALISON PATRICE (MD)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:PATRICE
Last Name:SOUTHERN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 TABS DR
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685
Mailing Address - Country:US
Mailing Address - Phone:330-563-0618
Mailing Address - Fax:330-563-0638
Practice Address - Street 1:3730 TABS DR
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-9562
Practice Address - Country:US
Practice Address - Phone:330-563-0618
Practice Address - Fax:330-563-0638
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35087577207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine