Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Southern Physician Group Management LLC

Organization Emergency Medicine Physician · NPI 1770162695

Southern Physician Group Management LLC is an Emergency Medicine Physician in Nacogdoches, Texas. Registered with an NPI since 2021.

In the registry since
2021
Specialties on file
2
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1204 N Mound St
Nacogdoches, TX 75961-4027
Phone: (936) 564-4611
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X
Emergency Medicine Physician Taxonomy 207P00000X

Record details

NPI number1770162695
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Grant Douglass — President · (361) 729-0646
NPI enumeratedApril 7, 2021
Last updated in NPPESJuly 26, 2022
Certification dateJuly 26, 2022
Mailing addressPo Box 200039, Dallas, TX 75320-0039

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