MEDICARE: SHEALY & HOLT

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	103TC0700X	Clinical Psychologist		AL

General Provider Information

NPI Number	:	1881812048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHEALY & HOLT

Provider Business Mailing Address
First Line	:	1613 RICHARD ARRINGTON JR BLVD S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-4952
Country	:	US
Telephone Number	:	205-933-7849
Fax Number	:	205-933-7880

Provider Business Practice Location Address
First Line	:	1613 RICHARD ARRINGTON JR BLVD S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-4952
Country	:	US
Telephone Number	:	205-933-7849
Fax Number	:	205-933-7880

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. BECKY P LANKFORD
Credential	:
Telephone Number	:	205-933-7849

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	05/24/2011

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