Southern Home Medical LLC

Primary specialty

Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X

Legal business name

SOUTHERN HOME MEDICAL LLC

Practice address

72 Kent Rd
Suite 6
Tifton, GA 31794-1694

Phone

(229) 396-5501

Fax

(229) 396-5503

NPI assigned

Feb 6, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Michael Raymond Connell

Title

Owner

Phone

(229) 392-0194

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

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

{
    "created_epoch": "1328486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345161600000",
    "number": "1598037632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72 KENT RD",
            "address_2": "SUITE 6",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317941694",
            "telephone_number": "229-396-5501",
            "fax_number": "229-396-5503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72 KENT RD",
            "address_2": "SUITE 6",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317941694",
            "telephone_number": "229-396-5501",
            "fax_number": "229-396-5503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN HOME MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-06",
        "last_updated": "2012-08-17",
        "status": "A",
        "authorized_official_last_name": "CONNELL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "RAYMOND",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "229-392-0194",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Southwell Ambulatory Inc
• Southwell Pharmacy
• Southwest Georgia Rehab, Inc

• Oxygen Equipment & Supplies (DME) in Tifton, GA
• Providers in Tifton, GA by specialty
• Oxygen Equipment & Supplies (DME) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.