Organization
SOUTHEAST MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUG RANDALL (MANAGING MEMBER)
(205) 308-3183
Entity
Organization
Contact information
Practice address
1930 EDWARDS LAKE RD STE 138B, BIRMINGHAM, AL 35235-3720
(205) 308-3183
(205) 278-6939
Mailing address
1930 EDWARDS LAKE RD STE 138, BIRMINGHAM, AL 35235-3720
(205) 534-5114
(205) 278-6939
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
02/11/2019
Last updated
02/11/2019
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