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General NPI Number Information
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NPI Number | 1376358481
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Entity Type | Organization
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Legal Business Name | SOUTHEAST ALABAMA SURGICAL LLC
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Dates
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Enumeration Date | 02/07/2025
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 107 OBRANNAN PARK DRIVE
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City | DOTHAN
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State | AL
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Zip | 36303
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Country | US
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Telephone | 478-330-5747
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Fax | 478-310-3105
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Provider Business Mailing Address
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Address Line | 1114 GA HIGHWAY 96 STE C1
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City | KATHLEEN
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State | GA
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Zip | 31047-4102
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Country | US
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Telephone | 478-330-5747
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Fax | 478-310-3105
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Authorized Official
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Title or Position | CEO
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Name | ASHA VOSS
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Credential | MD
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Telephone | 334-804-3536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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