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General NPI Number Information
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NPI Number | 1992938930
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Entity Type | Organization
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Legal Business Name | DESSELLE SURGICAL CLINIC, LLC
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Dates
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Enumeration Date | 08/25/2009
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Last Update Date | 01/06/2010
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Provider Practice Location Address
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Address Line | 203 AVALON AVE SUITE 290
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City | MUSCLE SHOALS
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State | AL
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Zip | 35661-2869
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Country | US
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Telephone | 256-386-1125
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Fax | 256-386-1126
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Provider Business Mailing Address
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Address Line | 203 AVALON AVE SUITE 290
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City | MUSCLE SHOALS
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State | AL
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Zip | 35661-2855
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Country | US
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Telephone | 256-386-1125
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Fax | 256-386-1126
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DIANE H. DAWSON
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Credential |
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Telephone | 256-386-1125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25005
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License Number State | AL
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