Southern Neurology, Physical Medicine & Rehabilitation, LLC

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

Legal business name

SOUTHERN NEUROLOGY, PHYSICAL MEDICINE & REHABILITATION, LLC

Practice address

4913 Lanes Pond Rd
Valdosta, GA 31601-1537

Phone

(229) 292-2074

NPI assigned

Mar 24, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tommy Keith Bussey

Title

Practice Manager

Phone

(229) 292-2074

Specialties & licenses 1

Addresses

Other names 1

• Southern Neurology, Physical Medicine & Rehabilitation, LLC Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585008000000",
    "number": "1013544899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4913 LANES POND RD",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316011537",
            "telephone_number": "229-292-2074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4913 LANES POND RD",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316011537",
            "telephone_number": "229-292-2074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN NEUROLOGY, PHYSICAL MEDICINE & REHABILITATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-24",
        "last_updated": "2020-03-24",
        "certification_date": "2020-03-24",
        "status": "A",
        "authorized_official_last_name": "BUSSEY",
        "authorized_official_first_name": "TOMMY",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "229-292-2074"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Neurology, Physical Medicine & Rehabilitation, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Neurology Physician in Valdosta, GA
• Providers in Valdosta, GA by specialty
• Neurology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.