Provider Demographics
NPI:1669007795
Name:SOUTHERN SPECIALTY PHYSICIANS LLC
Entity Type:Organization
Organization Name:SOUTHERN SPECIALTY PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:334-246-4774
Mailing Address - Street 1:7085 SYDNEY CURV
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3509
Mailing Address - Country:US
Mailing Address - Phone:334-246-4774
Mailing Address - Fax:833-963-2439
Practice Address - Street 1:7085 SYDNEY CURV
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3509
Practice Address - Country:US
Practice Address - Phone:334-246-4774
Practice Address - Fax:833-963-2439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty