Healthcare Provider Details

I. General information

NPI: 1619215381
Provider Name (Legal Business Name): SOUTHERN CANCER CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29653 ANCHOR CROSS BLVD SUTIE A 101
DAPHNE AL
36526-9594
US

IV. Provider business mailing address

29653 ANCHOR CROSS BLVD STE A101
DAPHNE AL
36526-9594
US

V. Phone/Fax

Practice location:
  • Phone: 251-607-5061
  • Fax: 251-607-5062
Mailing address:
  • Phone: 251-607-5061
  • Fax: 251-607-5062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LAUREN PETTIS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 251-625-6896