MEDICARE: MARSHALL MEDICAL CENTER SOUTH HEATHER KRAUSSE MD

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
1	2084P0804X	Child & Adolescent Psychiatry Physician	MD.29545	AL
2	2084P0800X	Psychiatry Physician	MD.29545	AL

General Provider Information

NPI Number	:	1669601720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARSHALL MEDICAL CENTER SOUTH HEATHER KRAUSSE MD

Provider Business Mailing Address
First Line	:	227 BRITTANY RD
Second Line	:
City	:	GUNTERSVILLE
State	:	AL
Zip	:	35976-5766
Country	:	US
Telephone Number	:	256-891-5102
Fax Number	:

Provider Business Practice Location Address
First Line	:	11491 US HIGHWAY 431
Second Line	:
City	:	ALBERTVILLE
State	:	AL
Zip	:	35950-0136
Country	:	US
Telephone Number	:	256-891-5102
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	STAN HUBBARD
Credential	:
Telephone Number	:	256-891-5102

Provider Enumeration Date	:	07/10/2009
Last Update Date	:	07/10/2009

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