Healthcare Provider Details

I. General information

NPI: 1770597262
Provider Name (Legal Business Name): SOUTHERN MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2159 ROCKY RIDGE RD SUITE 123
HOOVER AL
35216
US

IV. Provider business mailing address

2159 ROCKY RIDGE RD SUITE 123
HOOVER AL
35216
US

V. Phone/Fax

Practice location:
  • Phone: 205-822-1972
  • Fax: 205-822-2821
Mailing address:
  • Phone: 205-822-1972
  • Fax: 205-822-2821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number110489
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number110489
License Number StateAL
# 5
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number110489
License Number StateAL

VIII. Authorized Official

Name: MR. T. MICHAEL NELSON
Title or Position: PRESIDENT
Credential:
Phone: 205-822-1972