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NPI Code Detail

MEDICARE: NEPHROLOGY OF NORTH ALABAMA P.C.

MEDICARE: NEPHROLOGY OF NORTH ALABAMA P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RN0300XNephrology Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CK3006OTHERALRAILROAD MEDICARE

General Provider Information

NPI Number : 1417981622
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEPHROLOGY OF NORTH ALABAMA P.C.
Provider Business Mailing Address
First Line : 1216 SOMERVILLE RD SE
Second Line :
City : DECATUR
State : AL
Zip : 35601-4335
Country : US
Telephone Number : 256-340-0012
Fax Number : 256-340-1408
Provider Business Practice Location Address
First Line : 1216 SOMERVILLE ROAD SE
Second Line :
City : DECATUR
State : AL
Zip : 35601-3337
Country : US
Telephone Number : 256-340-0012
Fax Number : 256-340-1408
Authorized Official
Title or Position : OWNER
Name : DR. REGINALD DWAIN GLADISH
Credential : M.D.
Telephone Number : 256-340-0012
Provider Enumeration Date : 07/11/2006
Last Update Date : 05/16/2023

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