Graduated: 2000
NPI: 1336410190
Practice Locations (2)
SOUTHEASTERN PHYSICIAN SERVICES PC
2501 KENTUCKY AVE
PADUCAH, KY 420033813
2705752100
SOUTHEASTERN PHYSICIAN SERVICES PC
651 DUNLOP LN
CLARKSVILLE, TN 370405015
9315021370
Source: CMS National Downloadable File, September 2026.