Southern Cross Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

029957 Issued in GA

Legal business name

SOUTHERN CROSS SURGERY CENTER, LLC

Practice address

1301 Sigman Rd NE
Suite 120
Conyers, GA 30012-3812

Phone

(770) 760-9360

NPI assigned

May 19, 2011

Organization subpart

No

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

Authorized official

Name

Dr. R. L. Talley Jr., MD

Title

MD/Owner

Phone

(770) 760-9360

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Hospital certification: CCN 110245

Legal name

SOUTHERN CROSS SURGERY CENTER

Certification status

Terminated Voluntary: merger or closure, May 12, 2023

Provider type (POS)

Hospital – Short-term

Participating since

Sep 9, 2020

Last certification

Sep 9, 2020

Beds

1

Ownership / control type

Private (for profit)

Facility address

1301 Sigman Road NE, Suite 120
Conyers, GA 30012

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• MD Pain Care, P.C.

  • Pain Medicine (Anesthesiology) Physician
  • Conyers, GA
  • NPI 1336201664

  Member Of

  NPD member

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

{
    "created_epoch": "1305763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430265600000",
    "number": "1225321508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 SIGMAN RD NE",
            "address_2": "SUITE 120",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300123812",
            "telephone_number": "770-760-9360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 SIGMAN RD NE",
            "address_2": "SUITE 120",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300123812",
            "telephone_number": "770-760-9360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CROSS SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-19",
        "last_updated": "2015-04-29",
        "status": "A",
        "authorized_official_last_name": "TALLEY",
        "authorized_official_first_name": "R.",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "770-760-9360",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "GA",
            "license": "29957",
            "primary": false
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "029957",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "202G490818",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• South River Counseling & Consulting, LLC
• South Suburban Pathologists PC
• Southeast Heart and Vascular
• Southeastern Lung Care PC
• Southeastern Wound Care Services, Inc
• Southern Pain Institute P C
• Southern Pain Institute PC
• Sovereign Rehabilitation of Georgia, LLC
• Sovereign Rehabilitation of Georgia, LLC
• Yemi Joke Sowemimo, FNP

• Ambulatory Surgical Clinic/Center in Conyers, GA
• Providers in Conyers, GA by specialty
• Ambulatory Surgical Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.