Provider Demographics
NPI:1255382867
Name:SOUTH, BETHANY JULY (MD)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:JULY
Last Name:SOUTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-7840
Mailing Address - Fax:704-384-7830
Practice Address - Street 1:650 JULIAN RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-9078
Practice Address - Country:US
Practice Address - Phone:704-637-3373
Practice Address - Fax:704-637-0069
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200400980207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00713054OtherRAILROAD MEDICARE
NC3866591OtherCIGNA
NC5905046Medicaid
NC142TAOtherBCBS OF NC
NC1237673OtherAETNA
NC188300OtherMEDCOST
NC5710721OtherFIRST HEALTH
NC2054067AMedicare PIN
NC142TAOtherBCBS OF NC
NC0480730001Medicare NSC