Organization
SOUTHERN SURGICAL, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. WILMA F POND (OFFICE MANAGER)
(843) 399-9774
Entity
Organization
Contact information
Practice address
3600 SEA MOUNTAIN HWY, SUITE A, LITTLE RIVER, SC 29566-8161
(843) 399-9774
(843) 399-8657
Mailing address
PO BOX 599, LORIS, SC 29569-0599
(843) 399-9774
(843) 399-8657
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
890625V
—
NC
05
—
GP1384
—
SC
Enumeration date
10/25/2006
Last updated
01/25/2011
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