Healthcare Provider Details

I. General information

NPI: 1386683902
Provider Name (Legal Business Name): MELVIN DELAINE THORNBURY JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 N CARLISLE ST SUITE 220
ALBERTVILLE AL
35950-1733
US

IV. Provider business mailing address

415 MARTLING RD
ALBERTVILLE AL
35951-7209
US

V. Phone/Fax

Practice location:
  • Phone: 256-840-4520
  • Fax: 256-840-4527
Mailing address:
  • Phone: 256-660-5560
  • Fax: 256-660-5564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number14828
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: