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Contact Information

SOUTHEASTERN EMERGENCY SERVICES P C
1114 W MADISON AVE
ATHENS, TN37371
 Phone: 423-745-1411
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nurse Practitioner

363L00000X 50 Nurse Practitioner
 

Medical

363AM0700X 97 Physician Assistant
 

Pediatric Emergency Medicine

207PP0204X 93 Physician/Emergency Medicine
 

Pediatrics

363LP0200X 50 Nurse Practitioner
 

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for SOUTHEASTERN EMERGENCY SERVICES P C · (Female)

NPI Number 1669414264
Status Active
Credentials
Entity Individual
Enumeration date 06/11/2006
Last updated 09/14/2020 - About 6 years ago
Sole proprietor 1 Not specified
Identifiers
  • AL Medicaid 529929400
  • KY Medicaid 7100010470
  • KY Medicaid 78903671
  • MO Medicaid 507432003
  • MS Medicaid 02121280
  • MS Medicaid 05515899
  • MS Medicaid 06310389
  • NC Medicaid 2348298
  • SC Medicaid GP4818
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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