Organization
SOUTHEASTERN MEDICAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDAL L DABBS M.D. (PRESIDENT)
(865) 693-1000
Entity
Organization
Contact information
Practice address
260 HOSPITAL DR, BREVARD, NC 28712-3378
(828) 884-9111
Mailing address
PO BOX 636020, CINCINNATI, OH 45263-6020
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184669053
—
NC
05
—
3705406
—
TN
01
—
611073900
US DEPT LABOR
TN
01
—
DD8348
RRGA MEDICARE
TN
Enumeration date
06/17/2006
Last updated
10/09/2024
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