Southeastern Speciality Clinic

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

NC0726414 Issued in NC

Legal business name

SOUTHEASTERN SPECIALITY CLINIC

Practice address

520 Erwin Road
Dunn, NC 28334

Phone

(910) 292-2066

Fax

(910) 292-2091

NPI assigned

Sep 12, 2012

Organization subpart

No

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

Authorized official

Name

Theresa S Clarke, PHYSISIAN ASSISTANT,

Title

Ceo

Phone

(910) 292-2066

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1347408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347408000000",
    "number": "1861742462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 ERWIN ROAD",
            "city": "DUNN",
            "state": "NC",
            "postal_code": "28334",
            "telephone_number": "910-292-2066",
            "fax_number": "910-292-2091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 ERWIN ROAD",
            "city": "DUNN",
            "state": "NC",
            "postal_code": "28334",
            "telephone_number": "910-292-2066",
            "fax_number": "910-292-2091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN SPECIALITY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-12",
        "last_updated": "2012-09-12",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "910-292-2066",
        "authorized_official_credential": "PHYSISIAN ASSISTANT,"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "NC0726414",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Evelyn Patrick Slee, D.O.
• Camille Blue Smith
• Clifton Curtis Smith
• Lori Ann Sneeringer, PTA
• Southeastern Medical Center, P.C.
• Southmountain Children and Family Services
• Christiana Spears
• Shirley Jean Spears, SOCIAL WORKER
• Jonathan Banning Spivey, CRNA
• Tiffany S Spooner, MS OT

• Physician Assistant in Dunn, NC
• Providers in Dunn, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.