Healthcare Provider Details

I. General information

NPI: 1346625969
Provider Name (Legal Business Name): SELMA DOCTORS CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 07/24/2015
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
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 Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberRN1-111824
License Number StateAL

VIII. Authorized Official

Name: MRS. MARY ELIZABETH SWITZER
Title or Position: CRNP
Credential: CRNP
Phone: 334-874-9064