Healthcare Provider Details

I. General information

NPI: 1235295973
Provider Name (Legal Business Name): SOUTHERN ENT & SINUS CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 GADSDEN HWY
BIRMINGHAM AL
35235-3134
US

IV. Provider business mailing address

1809 GADSDEN HWY
BIRMINGHAM AL
35235-3134
US

V. Phone/Fax

Practice location:
  • Phone: 205-838-3755
  • Fax: 205-838-3758
Mailing address:
  • Phone: 205-838-3755
  • Fax: 205-838-3758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN ARRIS JEBELES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 205-838-3755