Southern Medical

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

Legal business name

SOUTHERN MEDICAL

Practice address

106 Free Hill Road
Hendersonville, TN 37075-3495

Phone

(615) 822-8888

Fax

(615) 822-8280

NPI assigned

Sep 8, 2005

Organization subpart

No

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

Authorized official

Name

Amber Blakely

Title

Ceo/Owner

Phone

(615) 822-8888

Specialties & licenses 1

Addresses

Other names 1

• ED MEDICAL INC Other name

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

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

{
    "created_epoch": "1126137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684368000000",
    "number": "1689668329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 FREE HILL ROAD",
            "city": "HENDERSONVILLE",
            "state": "TN",
            "postal_code": "370753495",
            "telephone_number": "615-822-8888",
            "fax_number": "615-822-8280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 FREE HILL ROAD",
            "city": "HENDERSONVILLE",
            "state": "TN",
            "postal_code": "370753495",
            "telephone_number": "615-822-8888",
            "fax_number": "615-822-8280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-08",
        "last_updated": "2023-05-18",
        "certification_date": "2023-05-18",
        "status": "A",
        "authorized_official_last_name": "BLAKELY",
        "authorized_official_first_name": "AMBER",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "615-822-8888"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ED MEDICAL INC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Ashley Sondrol
• Alexandra Souksangouane
• Kelley B. Southard, P.T.
• Southern Care Providers LLC
• Southern Medical
• Southern Sports Surgical, LLC.
• Haleigh Southern, FNP
• Clyde O Southwell, MD
• David Parker Sparks, MD
• Keita Spaulding, DMD

• Customized Equipment (DME) in Hendersonville, TN
• Providers in Hendersonville, TN by specialty
• Customized Equipment (DME) in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2023; 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.