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General NPI Number Information
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NPI Number | 1508306242
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Entity Type | Organization
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Legal Business Name | SELMA MEDICAL WEIGHT LOSS AND SPA
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Dates
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Enumeration Date | 02/28/2017
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 4 OFFICE PARK CIR
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City | SELMA
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State | AL
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Zip | 36701-6538
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Country | US
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Telephone | 334-872-7575
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Fax | 334-872-7574
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Provider Business Mailing Address
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Address Line | 4 OFFICE PARK CIR
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City | SELMA
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State | AL
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Zip | 36701-6538
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Country | US
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Telephone | 334-872-7575
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Fax | 334-872-7574
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Authorized Official
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Title or Position | PARTNER/MEDICAL DOCTOR
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Name | DR. SAI NAMBURU
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Credential | M.D.
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Telephone | 334-872-7575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MD26752
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License Number State | AL
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