Provider Demographics
NPI:1356727473
Name:SOUTHERN ACUPUNCTURE ASSOCIATES, LLC
Entity type:Organization
Organization Name:SOUTHERN ACUPUNCTURE ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:BAUER
Authorized Official - Last Name:COSLICK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC,
Authorized Official - Phone:912-308-1103
Mailing Address - Street 1:113 MCINTOSH DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-5245
Mailing Address - Country:US
Mailing Address - Phone:912-308-1103
Mailing Address - Fax:912-201-3327
Practice Address - Street 1:9100 WHITE BLUFF RD
Practice Address - Street 2:SUITE 601
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4668
Practice Address - Country:US
Practice Address - Phone:912-308-1103
Practice Address - Fax:912-201-3327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA229171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty