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General NPI Number Information
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NPI Number | 1669414264
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN EMERGENCY SERVICES P C
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 09/14/2020
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Provider Practice Location Address
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Address Line | 1114 W MADISON AVE
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City | ATHENS
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State | TN
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Zip | 37371
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Country | US
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Telephone | 423-745-1411
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Fax |
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Provider Business Mailing Address
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Address Line | P O BOX 634760
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City | CINCINNATI
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State | OH
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Zip | 45263-4760
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANDAL L DABBS
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Credential | M.D.
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Telephone | 865-693-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PP0204X
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Taxonomy Name | Pediatric Emergency Medicine (Emergency Medicine) 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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State | TN
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Taxonomy #6
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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