Southeast Medical Group LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

SOUTHEAST MEDICAL GROUP LLC

Practice address

1930 Edwards Lake Rd Ste 138B
Birmingham, AL 35235-3720

Phone

(205) 308-3183

Fax

(205) 278-6939

NPI assigned

Feb 11, 2019

Last updated

Feb 11, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Doug Randall

Title

Managing Member

Phone

(205) 308-3183

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1549843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549843200000",
    "number": "1871059212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1930 EDWARDS LAKE RD STE 138",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352353720",
            "telephone_number": "205-534-5114",
            "fax_number": "205-278-6939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 EDWARDS LAKE RD STE 138B",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352353720",
            "telephone_number": "205-308-3183",
            "fax_number": "205-278-6939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-11",
        "last_updated": "2019-02-11",
        "status": "A",
        "authorized_official_last_name": "RANDALL",
        "authorized_official_first_name": "DOUG",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "205-308-3183"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyle Southall
• Madelaine Stanback Southall
• Southeast Anesthesia Associates, LLC
• Southeast Clinical Laboratories LLC
• Southeast Diabetes, Inc.
• Southeast Rehab Medicine Inc
• Southeast Systemic Therapy and Consulting
• Southeaster Ocular Prosthetics
• Southeastern Brace, LLC (Alabama Pain Physicians)
• Southeastern Bracing LLC

• General Practice Physician in Birmingham, AL
• Providers in Birmingham, AL by specialty
• General Practice Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2019; 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.