Southern Surgical Providers, P.C.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

SOUTHERN SURGICAL PROVIDERS, P.C.

Practice address

459 Highway 119 S
Springfield, GA 31329-3021

Phone

(912) 754-0382

Fax

(912) 754-0382

NPI assigned

Oct 23, 2009

Organization subpart

No

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

Authorized official

Name

Robert Alexander Wynn, MDNPI 1790748432

Title

President

Phone

(912) 754-0382

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Tax ID family

Southern Surgical Provider2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Southern Surgical Providers, P.C.

  • Surgery Physician
  • Springfield, GA
  • NPI 1619398328
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robert Alexander Wynn, M.D.

  • Surgery Physician
  • Springfield, GA
  • NPI 1790748432
  Medicare reassignment Care Compare group NPD Authorized official
• Fawn B Smith, NP-C

  • Adult Health Nurse Practitioner
  • Springfield, GA
  • NPI 1679950554
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1256256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727481600000",
    "number": "1619203809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "459 HIGHWAY 119 S",
            "city": "SPRINGFIELD",
            "state": "GA",
            "postal_code": "313293021",
            "telephone_number": "912-754-0382",
            "fax_number": "912-754-0225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "459 HIGHWAY 119 S",
            "city": "SPRINGFIELD",
            "state": "GA",
            "postal_code": "313293021",
            "telephone_number": "912-754-0382",
            "fax_number": "912-754-0382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN SURGICAL PROVIDERS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-23",
        "last_updated": "2024-09-28",
        "certification_date": "2024-09-28",
        "status": "A",
        "authorized_official_last_name": "WYNN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "912-754-0382",
        "authorized_official_credential": "MD"
    },
    "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": "264241741A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ansley Smith
• Fawn B Smith, NP-C
• Southeast Lung & Critical Care Specialists, PC
• Southern Choices LLC
• Southern Choices of the Coast
• Southern Surgical Providers, P.C.
• Springfield Chiropractic LLC
• Kelli Stewart, NP
• Joseph Patrick Tallent, ATC
• Kimberly Bowen Thompson, M.ED., CCC-SLP

• Surgery Physician in Springfield, GA
• Providers in Springfield, GA by specialty
• Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2024; 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.