Healthcare Provider Details

I. General information

NPI: 1205808805
Provider Name (Legal Business Name): LEWIS E SELLERS III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 LEIGHTON AVE STE. 702
ANNISTON AL
36207-5700
US

IV. Provider business mailing address

901 LEIGHTON AVE STE. 702
ANNISTON AL
36207-5700
US

V. Phone/Fax

Practice location:
  • Phone: 256-237-1624
  • Fax: 256-238-0555
Mailing address:
  • Phone: 256-237-1624
  • Fax: 256-238-0555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number5848
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: