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General NPI Number Information
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NPI Number | 1396148169
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN CLINICS LLC
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Dates
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Enumeration Date | 10/07/2014
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Last Update Date | 10/07/2014
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Provider Practice Location Address
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Address Line | 114 HAMRIC DR E STE 5
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City | OXFORD
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State | AL
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Zip | 36203-2434
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Country | US
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Telephone | 256-403-5662
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Fax | 256-403-5673
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Provider Business Mailing Address
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Address Line | 114 HAMRIC DR E STE 5
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City | OXFORD
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State | AL
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Zip | 36203-2434
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Country | US
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Telephone | 256-403-5662
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Fax | 256-403-5673
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. DAVID GRAY
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Credential |
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Telephone | 256-310-3015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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