Healthcare Provider Details

I. General information

NPI: 1578629556
Provider Name (Legal Business Name): SOUTHERN CANCER CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 AIRPORT BLVD B BLDG., T LEVEL
MOBILE AL
36608-6705
US

IV. Provider business mailing address

29653 ANCHOR CROSS BLVD
DAPHNE AL
36526-9594
US

V. Phone/Fax

Practice location:
  • Phone: 251-625-6896
  • Fax:
Mailing address:
  • Phone: 251-625-6896
  • Fax: 251-625-6897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: LAUREN PETTIS
Title or Position: EXECUTIVE DIRECTOR
Credential: RN/OCN
Phone: 251-625-6896