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General NPI Number Information
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NPI Number | 1477553691
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Entity Type | Individual
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Provider Name | JOHN ALDUS ALEXANDER SELDOMRIDGE III MD
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Gender | Male
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Dates
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Enumeration Date | 07/29/2005
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 633 BROOKDALE DR SUITE 300
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City | STATESVILLE
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State | NC
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Zip | 28677-3451
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Country | US
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Telephone | 704-873-3250
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Fax | 704-873-2940
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Provider Business Mailing Address
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Address Line | PO BOX 1845
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City | STATESVILLE
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State | NC
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Zip | 28687-1845
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Country | US
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Telephone | 704-873-4277
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Fax | 704-978-3549
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 2002-00995
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 00026711
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License Number State | AL
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