MEDICARE: SOUTHEAST MEDICAL GROUP, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1891666210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST MEDICAL GROUP, P.C.

Provider Business Mailing Address
First Line	:	4300 NORTHPOINT PKWY STE 300
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30022-4102
Country	:	US
Telephone Number	:	470-704-3634
Fax Number	:

Provider Business Practice Location Address
First Line	:	7005 6TH AVE
Second Line	:
City	:	TUSCALOOSA
State	:	AL
Zip	:	35405-3990
Country	:	US
Telephone Number	:	205-345-4862
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CHRISTINE M AUYEUNG
Credential	:
Telephone Number	:	470-704-3634

Provider Enumeration Date	:	09/17/2025
Last Update Date	:	09/17/2025

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