Provider Demographics
NPI:1023419736
Name:SOUTHERN SURGICAL SPECIALTIES, LLC
Entity type:Organization
Organization Name:SOUTHERN SURGICAL SPECIALTIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:S
Authorized Official - Last Name:CULPEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-938-4931
Mailing Address - Street 1:PO BOX 1135
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31010-1135
Mailing Address - Country:US
Mailing Address - Phone:229-276-2004
Mailing Address - Fax:229-276-3641
Practice Address - Street 1:307 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-3208
Practice Address - Country:US
Practice Address - Phone:229-271-4620
Practice Address - Fax:229-271-4614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-12
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046072208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty