Provider Demographics
NPI:1043973498
Name:SOUTHLAND URO GYNECOLOGY ,LLC
Entity type:Organization
Organization Name:SOUTHLAND URO GYNECOLOGY ,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:LUKE
Authorized Official - Last Name:SEAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-474-6933
Mailing Address - Street 1:100 PLANTATION RIDGE DR.
Mailing Address - Street 2:UNIT D
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-5282
Mailing Address - Country:US
Mailing Address - Phone:229-474-6933
Mailing Address - Fax:888-815-1851
Practice Address - Street 1:100 PLANTATION RIDGE DR APT D
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-5282
Practice Address - Country:US
Practice Address - Phone:229-474-6933
Practice Address - Fax:888-815-1851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-21
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic SurgeryGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No2088F0040XAllopathic & Osteopathic PhysiciansUrologyUrogynecology and Reconstructive Pelvic SurgeryGroup - Multi-Specialty