Provider Demographics
NPI:1811096480
Name:SOUTHERN ENDOCRINOLOGY ASSOCIATES
Entity type:Organization
Organization Name:SOUTHERN ENDOCRINOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GANGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-909-8904
Mailing Address - Street 1:3500 I-30 AT MOTLEY
Mailing Address - Street 2:BUILDING D, SUITE # 203
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150
Mailing Address - Country:US
Mailing Address - Phone:972-682-5700
Mailing Address - Fax:
Practice Address - Street 1:3500 IH-30 BUIDLING D
Practice Address - Street 2:SUITE 203
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150
Practice Address - Country:US
Practice Address - Phone:972-682-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4788207RE0101X
NJMA07612100261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center