Healthcare Provider Details

I. General information

NPI: 1255400834
Provider Name (Legal Business Name): SOUTHEAST CANCER NETWORK, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 E SOUTH BLVD STE 202
MONTGOMERY AL
36116-2001
US

IV. Provider business mailing address

1400 AFFLINK PL STE 100
TUSCALOOSA AL
35406-2289
US

V. Phone/Fax

Practice location:
  • Phone: 334-281-7710
  • Fax:
Mailing address:
  • Phone: 205-366-9740
  • Fax: 205-344-9992

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 Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVE L MITCHELL
Title or Position: CFO
Credential:
Phone: 205-366-9740