Healthcare Provider Details

I. General information

NPI: 1376358481
Provider Name (Legal Business Name): SOUTHEAST ALABAMA SURGICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 OBRANNAN PARK DRIVE
DOTHAN AL
36303
US

IV. Provider business mailing address

1114 GA HIGHWAY 96 STE C1
KATHLEEN GA
31047-4102
US

V. Phone/Fax

Practice location:
  • Phone: 478-330-5747
  • Fax: 478-310-3105
Mailing address:
  • Phone: 478-330-5747
  • Fax: 478-310-3105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHA VOSS
Title or Position: CEO
Credential: MD
Phone: 334-804-3536