Provider Demographics
NPI:1396931929
Name:SOUTHERN MEDICAL OF JESUP LLC
Entity type:Organization
Organization Name:SOUTHERN MEDICAL OF JESUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-427-9185
Mailing Address - Street 1:102 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545
Mailing Address - Country:US
Mailing Address - Phone:912-427-9185
Mailing Address - Fax:912-427-2038
Practice Address - Street 1:102 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545
Practice Address - Country:US
Practice Address - Phone:912-427-9185
Practice Address - Fax:912-427-2038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies