Healthcare Provider Details

I. General information

NPI: 1467446237
Provider Name (Legal Business Name): SOUTHEASTERN PAIN & REHABILITATION PHYSICIANS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 RUBY TYLER PKWY
TUSCALOOSA AL
35404-2958
US

IV. Provider business mailing address

PO BOX 934585
ATLANTA GA
31193-4585
US

V. Phone/Fax

Practice location:
  • Phone: 205-759-7246
  • Fax: 205-759-7348
Mailing address:
  • Phone: 800-897-6169
  • Fax: 800-897-6170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WESLEY L SPRUILL
Title or Position: PRESIDENT
Credential: MD
Phone: 205-759-7246