# SOUTHEASTERN PHYSICIAN SERVICES PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083835441
- **Authorized official:** DR. RANDAL L DABBS MD (PRESIDENT)
- **Authorized official phone:** (888) 203-1274

## Contact information

- **Practice address:** 990 OAK RIDGE TPKE, OAK RIDGE, TN 37830-6976
- **Practice address phone:** (865) 481-1000
- **Mailing address:** PO BOX 635705, CINCINNATI, OH 45263-5705
- **Mailing address phone:** (888) 203-1274

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | TN | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | — |
| 207X00000X | Orthopaedic Surgery Physician | — | — | — |
| 208M00000X | Hospitalist Physician | — | TN | Yes |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |
| 363A00000X | Physician Assistant | — | TN | — |
| 363AM0700X | Medical Physician Assistant | — | NULL | — |
| 363AM0700X | Medical Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | TN | — |

## Other

- **Enumeration date:** 05/02/2007
- **Last updated:** 01/31/2020