NPIMap

Organization Active NPI

Southeastern Pediatric Associates, P.a.

  • Pediatrics Physician
  • Dothan, AL
National Provider Identifier
1093907412
Registry record updated Jan 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
SOUTHEASTERN PEDIATRIC ASSOCIATES, P.A.
Practice address
364 Honeysuckle Rd
Dothan, AL 36305-1140
Phone
(334) 794-8656
Fax
(337) 702-7047
NPI assigned
Aug 10, 2007
Last updated
Jan 12, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. S. Lucy Everett
Title
Office Manager
Phone
(334) 794-8656

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

364 Honeysuckle Rd
Dothan, AL 36305-1140

Mailing address

364 Honeysuckle Rd
Dothan, AL 36305-1140
Phone (334) 794-8656

Other identifiers 2

IdentifierTypeStateIssuer
528300110MedicaidAL
272658100MedicaidFL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D0304806Southeastern Pediatric Associates PA364 Honeysuckle Road, Dothan, AL 36305ComplianceJan 5, 2027

National Provider Directory

National Provider Directory

Locations

364 Honeysuckle Rd
Dothan, AL 36305
Phone (334) 794-8656

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294790400000",
    "number": "1093907412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "364 HONEYSUCKLE RD",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363051140",
            "telephone_number": "334-794-8656",
            "fax_number": "337-702-7047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "364 HONEYSUCKLE RD",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363051140",
            "telephone_number": "334-794-8656",
            "fax_number": "337-702-7047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN PEDIATRIC ASSOCIATES, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-10",
        "last_updated": "2011-01-12",
        "status": "A",
        "authorized_official_last_name": "EVERETT",
        "authorized_official_first_name": "S.",
        "authorized_official_middle_name": "LUCY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "334-794-8656",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "528300110",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "272658100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.