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General NPI Number Information
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NPI Number | 1669568838
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Entity Type | Organization
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Legal Business Name | SOUTHEAST SURGERY, PC
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4224 CARMICHAEL CT N
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City | MONTGOMERY
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State | AL
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Zip | 36106-3621
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Country | US
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Telephone | 334-270-8887
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Fax | 334-270-8837
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Provider Business Mailing Address
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Address Line | 2648 AIMEE DR
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City | MONTGOMERY
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State | AL
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Zip | 36106-3330
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Country | US
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Telephone | 334-270-8020
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Fax | 334-409-0956
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDWARD NEAL FOXHALL
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Credential | MD
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Telephone | 334-270-8020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 00016198
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License Number State | AL
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