{"npi":"1619203809","type":"NPI-2","status":"active","name":{"display":"Southern Surgical Providers, P.C.","other":[],"organization_name":"SOUTHERN SURGICAL PROVIDERS, P.C.","authorised_official":"Robert Wynn"},"specialty":{"primary_taxonomy":"208600000X","primary_taxonomy_description":"Surgery","slug":"surgery","schema_org_specialty":"Surgical","all":[{"code":"208600000X","description":"Surgery","primary":true,"state":null,"license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"459 HIGHWAY 119 S","city":"SPRINGFIELD","state":"GA","postal_code":"313293021","country_code":"US","phone":"9127540382","fax":"9127540382"},{"purpose":"MAILING","street_1":"459 HIGHWAY 119 S","city":"SPRINGFIELD","state":"GA","postal_code":"313293021","country_code":"US","phone":"9127540382","fax":"9127540225"}],"license":null,"identifiers":[{"type_code":"05","label":"Medicaid","value":"264241741A","state":"GA","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20100604000627","type_code":"12-70","type_desc":"PART B SUPPLIER - CLINIC/GROUP PRACTICE","state":"GA","pac_id":"3274663091"}]},"enumeration_date":"2009-10-23","last_updated":"2024-09-28","_meta":{"source":"NPPES","snapshot_date":"2024-09-28","doc_url":"https://findmynpi.com/api"}}