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General NPI Number Information
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NPI Number | 1184669053
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN MEDICAL GROUP, PC
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 260 HOSPITAL DR
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City | BREVARD
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State | NC
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Zip | 28712-3378
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Country | US
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Telephone | 828-884-9111
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 636020
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City | CINCINNATI
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State | OH
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Zip | 45263-6020
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANDAL L DABBS
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Credential | M.D.
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Telephone | 865-693-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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