Provider Demographics
NPI:1396148169
Name:SOUTHEASTERN CLINICS LLC
Entity type:Organization
Organization Name:SOUTHEASTERN CLINICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-310-3015
Mailing Address - Street 1:114 HAMRIC DR E STE 5
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203-2434
Mailing Address - Country:US
Mailing Address - Phone:256-403-5662
Mailing Address - Fax:256-403-5673
Practice Address - Street 1:114 HAMRIC DR E STE 5
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-2434
Practice Address - Country:US
Practice Address - Phone:256-403-5662
Practice Address - Fax:256-403-5673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty