Healthcare Provider Details

I. General information

NPI: 1396756730
Provider Name (Legal Business Name): BBSMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 ALISON DR SUITE 5
ALEXANDER CITY AL
35010-4469
US

IV. Provider business mailing address

125 ALISON DR SUITE 5
ALEXANDER CITY AL
35010-4469
US

V. Phone/Fax

Practice location:
  • Phone: 256-234-4443
  • Fax: 256-234-3686
Mailing address:
  • Phone: 256-234-4443
  • Fax: 256-234-3686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9546
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier51002295
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerBCBS PROVIDER NUMBER
# 2
Identifier51504902
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerBCBS PROVIDER NUMBER

VIII. Authorized Official

Name: DR. BILLY B. SELLERS JR.
Title or Position: OWNER
Credential: M.D.
Phone: 256-234-4443