Healthcare Provider Details

I. General information

NPI: 1174792279
Provider Name (Legal Business Name): ORTHOPAEDIC GROUP OF THE SOUTHEAST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MONTGOMERY HWY SUITE 200
BIRMINGHAM AL
35216-1842
US

IV. Provider business mailing address

200 MONTGOMERY HWY SUITE 200
BIRMINGHAM AL
35216-1842
US

V. Phone/Fax

Practice location:
  • Phone: 205-822-9595
  • Fax:
Mailing address:
  • Phone: 205-822-9595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: ROBERT SORRELL
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 205-822-9595