Healthcare Provider Details

I. General information

NPI: 1053252247
Provider Name (Legal Business Name): MR. ETHAN BRYCE TAUNTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9085 ELKAHATCHEE RD
ALEXANDER CITY AL
35010-6093
US

IV. Provider business mailing address

2316 WLAKER BUILDING
AUBURN AL
36849-0001
US

V. Phone/Fax

Practice location:
  • Phone: 256-537-0816
  • Fax:
Mailing address:
  • Phone: 334-844-8348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberS14684
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: