Provider Demographics
NPI:1023358660
Name:SOUTHEASTERN MEDICAL MANAGEMENT ASSOCIATES
Entity Type:Organization
Organization Name:SOUTHEASTERN MEDICAL MANAGEMENT ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:SNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-300-9618
Mailing Address - Street 1:PO BOX 241983
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36124-1983
Mailing Address - Country:US
Mailing Address - Phone:334-300-9618
Mailing Address - Fax:
Practice Address - Street 1:6713 OLD LEEDS RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-2407
Practice Address - Country:US
Practice Address - Phone:334-300-9618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-19
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9116005205302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization