Healthcare Provider Details

I. General information

NPI: 1538511340
Provider Name (Legal Business Name): MARSHALL MEDICAL CENTER SOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11491 US HIGHWAY 431
ALBERTVILLE AL
35950-0136
US

IV. Provider business mailing address

11491 US HIGHWAY 431
ALBERTVILLE AL
35950-0136
US

V. Phone/Fax

Practice location:
  • Phone: 256-593-8310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: GARY GORE
Title or Position: CEO
Credential:
Phone: 256-571-8000