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Organization

SOUTHEASTERN EMERGENCY SERVICES P C

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
1114 W MADISON AVE, ATHENS, TN 37371
(423) 745-1411
Mailing address
P O BOX 634760, CINCINNATI, OH 45263-4760

Taxonomy

Speciality
Code
Description
License number
State
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
363A00000X
Physician Assistant
363AM0700X
Medical Physician Assistant
363L00000X
Nurse Practitioner
TN
363L00000X
Nurse Practitioner
Primary
363LP0200X
Pediatric Nurse Practitioner
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02121280
MS
05
05515899
MS
05
06310389
MS
05
2348298
NC
05
507432003
MO
05
529929400
AL
05
7100010470
KY
05
78903671
KY
05
GP4818
SC
Enumeration date
06/11/2006
Last updated
09/14/2020
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