Healthcare Provider Details

I. General information

NPI: 1669007795
Provider Name (Legal Business Name): SOUTHERN SPECIALTY PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7085 SYDNEY CURV
MONTGOMERY AL
36117-3509
US

IV. Provider business mailing address

7085 SYDNEY CURV
MONTGOMERY AL
36117-3509
US

V. Phone/Fax

Practice location:
  • Phone: 334-246-4774
  • Fax: 833-963-2439
Mailing address:
  • Phone: 334-246-4774
  • Fax: 833-963-2439

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: BRIAN LEE SELLERS
Title or Position: MEMBER
Credential: DO
Phone: 334-246-4774