Provider Demographics
NPI:1710137575
Name:SOUTHERN HEAD & NECK SURGERY
Entity Type:Organization
Organization Name:SOUTHERN HEAD & NECK SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-329-1114
Mailing Address - Street 1:3368 HIGHWAY 280
Mailing Address - Street 2:SUITE G-15
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-3393
Mailing Address - Country:US
Mailing Address - Phone:256-329-1114
Mailing Address - Fax:256-329-3339
Practice Address - Street 1:3368 HIGHWAY 280
Practice Address - Street 2:SUITE G-15
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-3393
Practice Address - Country:US
Practice Address - Phone:256-329-1114
Practice Address - Fax:256-329-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL16702207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALAL16702OtherSTATE LICENSE NUMBER
ALAL16702OtherSTATE LICENSE NUMBER