NPIMap

Organization Active NPI

Southern Center for Orthopedics

Doing business as Southern Orthopedics Sports Medicine

  • Orthopaedic Surgery Physician
  • Lagrange, GA
National Provider Identifier
1073654489
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
23336 Issued in GA
Legal business name
SOUTHERN CENTER FOR ORTHOPEDICS
Doing business as
Southern Orthopedics Sports Medicine
Practice address
1805 Vernon Rd
Suite B
Lagrange, GA 30240-4041
Phone
(706) 884-2691
Fax
(706) 845-7314
NPI assigned
Feb 9, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Gloria W Kelley
Title
Executive Secretary
Phone
(706) 884-2691

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X 23336 GA Primary

Addresses

Primary practice location

1805 Vernon Rd
Suite B
Lagrange, GA 30240-4041

Mailing address

1805 Vernon Rd
Suite B
Lagrange, GA 30240-4041
Phone (706) 884-2691

Other names 1

  • Southern Orthopedics Sports Medicine Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073654489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 VERNON RD",
            "address_2": "SUITE B",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302404041",
            "telephone_number": "706-884-2691",
            "fax_number": "706-845-7314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 VERNON RD",
            "address_2": "SUITE B",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302404041",
            "telephone_number": "706-884-2691",
            "fax_number": "706-845-7314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CENTER FOR ORTHOPEDICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KELLEY",
        "authorized_official_first_name": "GLORIA",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "EXECUTIVE SECRETARY",
        "authorized_official_telephone_number": "706-884-2691",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "GA",
            "license": "23336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Orthopedics Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lagrange, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.