# SOUTHERN MEDICAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073544508
- **Authorized official:** JEAN MORRIS BILLING (BILLING)
- **Authorized official phone:** (870) 234-5995

## Contact information

- **Practice address:** 211 E STADIUM, MAGNOLIA, AR 71753-2032
- **Practice address phone:** (870) 234-5995
- **Practice address fax:** (870) 234-0278
- **Mailing address:** 211 E STADIUM, MAGNOLIA, AR 71753-2032
- **Mailing address phone:** (870) 234-5995
- **Mailing address fax:** (870) 234-0278

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 07/05/2006
- **Last updated:** 06/19/2012