SOUTHEAST MEDICAL GROUP LLC NPI 1871059212

NPI Information

SOUTHEAST MEDICAL GROUP LLC is a general practice in Birmingham, AL. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee SOUTHEAST MEDICAL GROUP LLC NPI is 1871059212. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1930 EDWARDS LAKE RD STE 138B
BIRMINGHAM, AL
ZIP 35235-720
Phone: (205) 308-3183
Fax: (205) 278-6939

The provider's authorized official is Doug Randall .
The authorized official title is Managing Member and has the following contact phone number (205) 308-3183.

The enumeration date for this NPI number is 2/11/2019 and was last updated on 2/11/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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