Provider Demographics
NPI:1295907889
Name:SEALE HARRIS CLINIC
Entity type:Organization
Organization Name:SEALE HARRIS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:CRENSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-595-5504
Mailing Address - Street 1:805 SAINT VINCENTS DR
Mailing Address - Street 2:SUITE 510
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1636
Mailing Address - Country:US
Mailing Address - Phone:205-595-5504
Mailing Address - Fax:205-592-3427
Practice Address - Street 1:805 SAINT VINCENTS DR
Practice Address - Street 2:SUITE 510
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1636
Practice Address - Country:US
Practice Address - Phone:205-595-5504
Practice Address - Fax:205-592-3427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.27684207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510I080216Medicare PIN