Organization
SOUTHEASTERN MEDICAL, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALICIA BERRY (INSURANCE SUPERVISOR)
(910) 287-7001
Entity
Organization
Contact information
Practice address
830 SUNSET BLVD N, SUNSET BEACH, NC 28468-4262
(910) 575-5750
Mailing address
830 SUNSET BLVD N, SUNSET BEACH, NC 28468-4262
(910) 575-5750
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8911413
—
NC
Enumeration date
07/31/2019
Last updated
07/31/2019
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