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Organization
SOUTHERN MEDICINE PRIMARY & URGENT CARE, INC
Active
Organization
SOUTHERN MEDICINE PRIMARY & URGENT CARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE MORRIS APRN (PRESIDENT)
(386) 209-0638
Entity
Organization
Contact information
Practice address
1405 OHIO AVE N, LIVE OAK, FL 32064-4868
(386) 209-0638
(386) 219-0470
Mailing address
PO BOX 6006, LIVE OAK, FL 32064-6006
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12624827
CAQH
—
Enumeration date
06/15/2020
Last updated
05/17/2022
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