Organization
SOUTHSIDE SURGICAL SPECIALISTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JOAN C MARTIN (OFFICE MANAGER)
(434) 792-5964
Entity
Organization
Contact information
Practice address
159 EXECUTIVE DR STE B, DANVILLE, VA 24541-4160
(434) 792-5964
(434) 792-5971
Mailing address
159 EXECUTIVE DR STE B, DANVILLE, VA 24541-4160
(434) 792-5964
(434) 792-5971
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0101232606
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007300107
—
VA
05
—
007308345
—
VA
05
—
010151163
—
VA
05
—
7312580
—
VA
Enumeration date
09/27/2006
Last updated
06/17/2008
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