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Organization
SOUTHERN MEDICAL ASSOCIATES, P.A.
Active
Organization
SOUTHERN MEDICAL ASSOCIATES, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN M. JOHNSON (PRACTICE MANAGER)
(843) 756-7885
Entity
Organization
Contact information
Practice address
3418 CASEY ST, LORIS, SC 29569-2904
(843) 756-7885
(843) 756-7855
Mailing address
3418 CASEY ST, LORIS, SC 29569-2904
(843) 756-7885
(843) 756-7855
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP0042
—
SC
Enumeration date
09/28/2006
Last updated
08/22/2020
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