SOUTHERN ORTHOPAEDICS AND SPORTS MEDICINE (NPI# 1104228469) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104228469 |
| Entity Type | Organization |
| Organization Name | SOUTHERN ORTHOPAEDICS AND SPORTS MEDICINE |
| Practice Address |
3231 Glynn Ave Brunswick GA 31520-4851 |
| Practice Telephone | 9122659006 |
| Mailing Telephone | 9122659006 |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2014-09-18 |
| Authorized Official Name | DR. GERALD L JOHNSON (PRACTICE ADMINISTRATIVE OFFICER) |
| Authorized Official Telephone | 9122659006 |
| Authorized Official Credential | MHA/MBA/ PH.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2000X |
Clinic/Center Specialization: Physical Therapy |
PT011539 | GA | Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427156827 | Southern Orthopaedics and Sports Medicine | Specialist | 1823 N 9th Ave Ste 534, Pensacola, FL 32503-5270 | 2006-09-20 |
| Street Address |
3231 GLYNN AVE |
| City | BRUNSWICK |
| State | GA |
| Zip Code | 31520-4851 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841297017 | Brian C Boyd | Physical Therapist | 3231 Glynn Ave, Brunswick, GA 31520-4851 | 2005-07-04 |
| 1861865743 | Mark Dunham | Nurse Practitioner | 3231 Glynn Ave, Brunswick, GA 31520-4851 | 2015-11-02 |
| 1265810204 | Richard Burrell | Physician Assistant | 3231 Glynn Ave, Brunswick, GA 31520-4851 | 2015-05-11 |
| 1053691758 | Audrey E Herbert | Physical Therapist | 3231 Glynn Ave, Brunswick, GA 31520-4851 | 2011-08-25 |
| 1326280280 | Richard C Sipe | Physician Assistant | 3231 Glynn Ave, Brunswick, GA 31520-4851 | 2009-03-24 |
| 1689603029 | Derek E Rhodes | Physical Therapist | 3231 Glynn Ave, Brunswick, GA 31520-4851 | 2006-06-30 |
| 1477589737 | Southern Orthopaedics and Sports Medicine, P.C. | Orthopaedic Surgery | 3231 Glynn Ave, Brunswick, GA 31520-4851 | 2006-06-25 |
| 1780620211 | Raymond F Topp | Orthopaedic Surgery | 3231 Glynn Ave, Brunswick, GA 31520-4851 | 2006-06-22 |
| 1366430233 | Jackie Kevin Brooks | Orthopaedic Surgery | 3231 Glynn Ave, Brunswick, GA 31520-4851 | 2005-10-13 |
| 1790773703 | Ralph W Morales | Orthopaedic Surgery | 3231 Glynn Ave, Brunswick, GA 31520-4851 | 2005-10-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760953434 | David S Deuser Md & Associates PC | Psychiatry & Neurology | 7 Saint Andrews Court, Brunswick, GA 31520 | 2018-12-06 |
| 1063961845 | Irene Limon | Licensed Practical Nurse | 2009 Ellis Street, Brunswick, GA 31520 | 2016-09-22 |
| 1770936551 | Elaine Latimer-tandy | Counselor | 1801 Gloucester St Ste E, Brunswick, GA 31520 | 2016-07-18 |
| 1710336326 | Giva, Inc. | Home Health | 8 St Andrews Court, Brunswick, GA 31520 | 2016-06-06 |
| 1447618525 | Parmelee Eye Care LLC | Point of Service | 1909 Gloucester St, Brunswick, GA 31520 | 2016-02-04 |
| 1578947800 | Holly Diskin Kinsey | Nurse Practitioner | 3400 Parkwood Drive, Brunswick, GA 31520 | 2015-07-16 |
| 1679976419 | Miriam Hosey | Registered Nurse | 2747 Fourth Street, Glynn County Health Dept., Brunswick, GA 31520 | 2014-10-08 |
| 1558779348 | Tracey Renee Price | Internal Medicine | 3025 Shrine Rd Ste 290, Brunswick, GA 31520 | 2014-07-24 |
| 1770901951 | Candace Shepherd | Social Worker | 707 F Street, Brunswick, GA 31520 | 2014-04-03 |
| 1699193599 | Enrique Martinez, M.d., P.C. | Internal Medicine | 3114 A Shrine Road, Brunswick, GA 31520 | 2014-03-29 |
| Find all providers in zip 31520 | ||||
| Taxonomy Code | 261QP2000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Physical Therapy |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437389269 | Select Physical Therapy Holdings, Inc. | Clinic/Center | 3625 College Station, Brunswick, ME 04011-8427 | 2009-07-14 |
| 1023244266 | Child Development Services Search | Clinic/Center | 35a Gurnet Road, Brunswick, ME 04011-2744 | 2009-06-02 |
| 1275790305 | Select Physical Therapy Holdings Inc | Clinic/Center | 3265 College Sta, Brunswick, ME 04011-8423 | 2008-05-16 |
| 1962999821 | Occupational Healh Centers of The Southwest, P.a. | Clinic/Center | 11 Medical Center Dr, Brunswick, ME 04011-2690 | 2018-04-17 |
| 1366582355 | Lindy Ost | Clinic/Center | 4 Riverview Dr, Brunswick, ME 04011-1632 | 2007-02-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982205159 | Thrive Therapy and Wellness Services LLC | Clinic/Center | 106 Mims Rd, Sylvania, GA 30467-1995 | 2020-11-04 |
| 1851990063 | On The Move Massage & Physical Therapy | Clinic/Center | 7454 Silver Arrow Trl, Austell, GA 30168-2401 | 2020-10-19 |
| 1659979086 | Mvp Physio Dr. | Clinic/Center | 123 Umiya Nagar Cir, Macon, GA 31206-5401 | 2020-10-16 |
| 1972100865 | Resilient Physio, LLC | Clinic/Center | 790 West Ave, Cartersville, GA 30120-3402 | 2020-10-05 |
| 1205441987 | Fortitude Movement & Strength Inc. | Clinic/Center | 5300 Peachtree Rd Unit 2508, Atlanta, GA 30341-2457 | 2020-09-10 |
| 1376151001 | Mother and Baby Wellness Collective, LLC | Clinic/Center | 136 Millstone Way, Canton, GA 30115-7270 | 2020-07-20 |
| 1225646821 | Innovative Therapeutic Solutions, LLC | Clinic/Center | 360 Pharr Rd Ne Apt 404, Atlanta, GA 30305-2391 | 2020-07-20 |
| 1669090544 | Active Body Physiotherapy | Clinic/Center | 2968 Ask Kay Dr Se Ste B, Smyrna, GA 30082-2304 | 2020-07-08 |
| 1487270914 | Docjay Physical Therapy | Clinic/Center | 6740 Shannon Pkwy Ste 14, Union City, GA 30291-2061 | 2020-06-20 |
| 1477176923 | R & J Health Care | Clinic/Center | 6853b Douglas Blvd Ste B, Douglasville, GA 30135 | 2020-05-19 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.