General Surgery of Southaven LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

GENERAL SURGERY OF SOUTHAVEN LLC

Practice address

401 Southcrest Cir
Suite 210
Southaven, MS 38671-6726

Phone

(662) 536-1944

Fax

(662) 536-1947

NPI assigned

Aug 17, 2006

Organization subpart

No

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

Authorized official

Name

Daniel Benjamin Fore, M.D.

Title

Owner

Phone

(662) 536-1944

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458777600000",
    "number": "1164535415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 SOUTHCREST CIR",
            "address_2": "SUITE 210",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386716726",
            "telephone_number": "662-536-1944",
            "fax_number": "662-536-1947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 SOUTHCREST CIR",
            "address_2": "SUITE 210",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386716726",
            "telephone_number": "662-536-1944",
            "fax_number": "662-536-1947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENERAL SURGERY OF SOUTHAVEN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-17",
        "last_updated": "2016-03-24",
        "status": "A",
        "authorized_official_last_name": "FORE",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "BENJAMIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-536-1944",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03873250",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rashidah Gardner, LMSW
• Lindsey Garner, FNP-C
• Bailey Lea Garrett, PMHNP-BC
• Beverly Garrison, RMT
• Terri Darlene Gatton, D.C.
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• Genoa Healthcare LLC
• Gentle Butterfly MPS LLC
• Nicole L George, APRN
• Jakeya Geter, LPN

• All providers in Southaven, MS
• Surgery Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2016; 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.