Provider Demographics
NPI:1750870812
Name:SELMA FAMILY CARE PC
Entity type:Organization
Organization Name:SELMA FAMILY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BOHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-375-8007
Mailing Address - Street 1:PO BOX 570
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36702-0570
Mailing Address - Country:US
Mailing Address - Phone:334-375-8007
Mailing Address - Fax:
Practice Address - Street 1:SELMA FAMILY CARE, PC
Practice Address - Street 2:203 VAUGHAN MEMORIAL DRIVE
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6950
Practice Address - Country:US
Practice Address - Phone:334-375-8007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty