Individual
ROGER A SOUTHALL, JR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
9263 MEDICAL PLAZA DR, STE E, CHARLESTON, SC 29406-7112
(843) 572-1228
(877) 561-7564
Mailing address
9263 MEDICAL PLAZA DR, STE E, CHARLESTON, SC 29406-7112
(843) 572-1228
(877) 561-7564
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
18138
SC
390200000X
Student in an Organized Health Care Education/Training Program
9302221
FL
Other
Enumeration date
10/30/2012
Last updated
01/29/2013
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