Healthcare Provider Details

I. General information

NPI: 1972515906
Provider Name (Legal Business Name): JAMIE L. SHERIDAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE L LEITHEISER MD

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 SCHILLINGER ROAD SOUTH SUITE A
MOBILE AL
36695
US

IV. Provider business mailing address

P.O .BOX 7627
MOBILE AL
36670-0627
US

V. Phone/Fax

Practice location:
  • Phone: 251-633-0123
  • Fax: 251-410-6127
Mailing address:
  • Phone: 251-633-7211
  • Fax: 251-410-6079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5136
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: