NPIMap

Organization Active NPI

Southern Retina LLC

  • Surgery Physician
  • Savannah, GA
National Provider Identifier
1710028287
Registry record updated Oct 25, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
SOUTHERN RETINA LLC
Practice address
5354 Reynolds St
Suite 317
Savannah, GA 31405-6007
Phone
(912) 353-7900
NPI assigned
Feb 9, 2007
Last updated
Oct 25, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2007

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

Authorized official

Name
Dr. Charles L Harris, MDNPI 1427016534
Title
Owner
Phone
(912) 353-7900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

5354 Reynolds St
Suite 317
Savannah, GA 31405-6007

Mailing address

5354 Reynolds St
Suite 317
Savannah, GA 31405-6007
Phone (912) 353-7900

Other identifiers 2

IdentifierTypeStateIssuer
GPA790MedicaidSC
00829551EMedicaidGA

National Provider Directory

National Provider Directory

Locations

5354 Reynolds St
Ste 317
Savannah, GA 31405
Phone (912) 353-7900

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193270400000",
    "number": "1710028287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5354 REYNOLDS ST",
            "address_2": "SUITE 317",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314056007",
            "telephone_number": "912-353-7900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5354 REYNOLDS ST",
            "address_2": "SUITE 317",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314056007",
            "telephone_number": "912-353-7900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN RETINA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2007-10-25",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-353-7900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GPA790",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00829551E",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Savannah, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2007; 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.