Healthcare Provider Details

I. General information

NPI: 1346240470
Provider Name (Legal Business Name): SOUTHEASTERN PSYCHIATRIC MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 SCENIC HWY
GADSDEN AL
35904-3047
US

IV. Provider business mailing address

3001 SCENIC HWY
GADSDEN AL
35904-3047
US

V. Phone/Fax

Practice location:
  • Phone: 256-546-9265
  • Fax: 256-549-0376
Mailing address:
  • Phone: 256-546-9265
  • Fax: 256-549-0376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number10347
License Number StateAL

VIII. Authorized Official

Name: MS. KELLY GEWALT
Title or Position: NETWORKING MANAGER
Credential:
Phone: 256-546-9265