Healthcare Provider Details

I. General information

NPI: 1558205211
Provider Name (Legal Business Name): SOUTHERN VASCULAR ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 OLD SHELL RD
MOBILE AL
36604-1354
US

IV. Provider business mailing address

1551 OLD SHELL RD
MOBILE AL
36604-1354
US

V. Phone/Fax

Practice location:
  • Phone: 251-379-5318
  • Fax: 251-379-5318
Mailing address:
  • Phone: 251-379-5318
  • Fax: 251-379-5318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIE SMITH
Title or Position: OFFICE MANAGER
Credential:
Phone: 251-379-5318