Provider Demographics
NPI:1902652704
Name:SOUTHERN ORTHOPAEDIC ALLIANCE PLLC
Entity Type:Organization
Organization Name:SOUTHERN ORTHOPAEDIC ALLIANCE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:ZARZOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-654-3798
Mailing Address - Street 1:PO BOX 117709
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-7709
Mailing Address - Country:US
Mailing Address - Phone:251-435-2663
Mailing Address - Fax:
Practice Address - Street 1:75 SHELL ST STE 200
Practice Address - Street 2:
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-2202
Practice Address - Country:US
Practice Address - Phone:251-435-2663
Practice Address - Fax:251-435-1098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies