Healthcare Provider Details

I. General information

NPI: 1598714461
Provider Name (Legal Business Name): AJC HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3691 DADEVILLE RD
ALEXANDER CITY AL
35010-4501
US

IV. Provider business mailing address

3691 DADEVILLE RD
ALEXANDER CITY AL
35010-4501
US

V. Phone/Fax

Practice location:
  • Phone: 256-234-6366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number060551
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ARCHIE CHAPMAN
Title or Position: OWNER
Credential:
Phone: 256-234-3633