Organization
SOUTHERN SURGICAL PROVIDERS, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT ALEXANDER WYNN MD (PRESIDENT)
(912) 754-0382
Entity
Organization
Contact information
Practice address
459 HIGHWAY 119 S, SPRINGFIELD, GA 31329-3021
(912) 754-0382
(912) 754-0382
Mailing address
459 HIGHWAY 119 S, SPRINGFIELD, GA 31329-3021
(912) 754-0382
(912) 754-0225
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
264241741A
—
GA
Enumeration date
10/23/2009
Last updated
09/28/2024
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