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General NPI Number Information
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NPI Number | 1093954844
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Entity Type | Organization
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Legal Business Name | SOUTHEAST DIABETES, INC.
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Dates
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Enumeration Date | 02/17/2009
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Last Update Date | 01/20/2023
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Provider Practice Location Address
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Address Line | 11 INVERNESS CENTER PKWY
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City | BIRMINGHAM
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State | AL
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Zip | 35242-4823
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Country | US
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Telephone | 205-783-5111
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Fax | 888-470-6890
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Provider Business Mailing Address
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Address Line | 31 INVERNESS CENTER PKWY STE 400
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City | BIRMINGHAM
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State | AL
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Zip | 35242-4823
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Country | US
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Telephone | 205-783-5111
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Fax | 888-470-6890
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MR. JOHN CARTER
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Credential |
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Telephone | 205-783-5111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 20092586
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License Number State | AL
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