Healthcare Provider Details

I. General information

NPI: 1891776050
Provider Name (Legal Business Name): SELMA DOCTORS CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 PARKMAN AVE
SELMA AL
36701-5734
US

IV. Provider business mailing address

509 PARKMAN AVE P.O. BOX 530
SELMA AL
36701-5734
US

V. Phone/Fax

Practice location:
  • Phone: 334-874-9064
  • Fax: 334-874-2633
Mailing address:
  • Phone: 334-874-9064
  • Fax: 334-874-2633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ALICE HINSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 334-874-9064