Organization
DESSELLE SURGICAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE H. DAWSON (OFFICE MANAGER)
(256) 386-1125
Entity
Organization
Contact information
Practice address
203 AVALON AVE, SUITE 290, MUSCLE SHOALS, AL 35661-2869
(256) 386-1125
(256) 386-1126
Mailing address
203 AVALON AVE, SUITE 290, MUSCLE SHOALS, AL 35661-2855
(256) 386-1125
(256) 386-1126
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25005
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102I029080
MEDICARE PTAN
AL
05
—
114470
—
AL
05
—
1477478
—
LA
01
—
510-49740
BLUE CROSS BLUE SHIELD
AL
Enumeration date
08/25/2009
Last updated
01/06/2010
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