NPIMap

Organization Active NPI

John K. Southard, Jr., M.D., P.a.

  • Specialist
  • Winston Salem, NC
National Provider Identifier
1437233962
Registry record updated Mar 31, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
18576 Issued in NC
Legal business name
JOHN K. SOUTHARD, JR., M.D., P.A.
Practice address
1345 Westgate Center Dr
Suite B
Winston Salem, NC 27103-3040
Phone
(336) 768-1280
Fax
(336) 760-8443
NPI assigned
Oct 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2009

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

Authorized official

Name
Dr. John K Southard Jr., M.D.
Title
President
Phone
(336) 768-1280

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 18576 NC Primary

Addresses

Primary practice location

1345 Westgate Center Dr
Suite B
Winston Salem, NC 27103-3040

Mailing address

1345 Westgate Center Dr
Suite B
Winston Salem, NC 27103-3040
Phone (336) 768-1280

Other identifiers 1

IdentifierTypeStateIssuer
89013U8MedicaidNC

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238457600000",
    "number": "1437233962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1345 WESTGATE CENTER DR",
            "address_2": "SUITE B",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271033040",
            "telephone_number": "336-768-1280",
            "fax_number": "336-760-8443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1345 WESTGATE CENTER DR",
            "address_2": "SUITE B",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271033040",
            "telephone_number": "336-768-1280",
            "fax_number": "336-760-8443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN K. SOUTHARD, JR., M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2009-03-31",
        "status": "A",
        "authorized_official_last_name": "SOUTHARD",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-768-1280",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NC",
            "license": "18576",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89013U8",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2009; 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.