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General NPI Number Information
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NPI Number | 1578629556
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Entity Type | Organization
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Legal Business Name | SOUTHERN CANCER CENTER, PC
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 6701 AIRPORT BLVD
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City | MOBILE
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State | AL
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Zip | 36608-6705
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Country | US
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Telephone | 251-625-6896
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Fax | 251-266-3209
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Provider Business Mailing Address
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Address Line | 29653 ANCHOR CROSS BLVD
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City | DAPHNE
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State | AL
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Zip | 36526-9594
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Country | US
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Telephone | 251-625-6896
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Fax | 251-625-6897
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LAUREN PETTIS
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Credential | RN/OCN
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Telephone | 251-625-6896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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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 | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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