# SOUTHERN PINES FAMILY MEDICAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southern Pines Family Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245326149
- **Authorized official:** DR. GLENN BUTT M D (MEMBER)
- **Authorized official phone:** (985) 863-7100

## Contact information

- **Practice address:** 64629 HIGHWAY 41, PEARL RIVER, LA 70452-3611
- **Practice address phone:** (985) 863-7100
- **Mailing address:** PO BOX 1659, PEARL RIVER, LA 70452-1659
- **Mailing address phone:** (985) 863-7100

## Taxonomy

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

## Other

- **Enumeration date:** 10/05/2006
- **Last updated:** 06/08/2011