Healthcare Provider Details

I. General information

NPI: 1447628060
Provider Name (Legal Business Name): S.B.J.S.,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 N MAIN ST
ENTERPRISE AL
36330-2563
US

IV. Provider business mailing address

PO BOX 729
DOTHAN AL
36302-0729
US

V. Phone/Fax

Practice location:
  • Phone: 334-308-9797
  • Fax: 334-308-2909
Mailing address:
  • Phone: 334-793-2663
  • Fax: 334-836-2248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM BERRY SOWELL
Title or Position: CEO
Credential:
Phone: 334-793-2663