Healthcare Provider Details

I. General information

NPI: 1780096263
Provider Name (Legal Business Name): HEART INSTITUTE OF ANDALUSIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 MEDICAL PARK DR SUITE 1
ANDALUSIA AL
36420-5354
US

IV. Provider business mailing address

215 MEDICAL PARK DR SUITE 1
ANDALUSIA AL
36420-5354
US

V. Phone/Fax

Practice location:
  • Phone: 334-222-4327
  • Fax: 334-222-4333
Mailing address:
  • Phone: 334-222-4327
  • Fax: 334-222-4333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: GREGORY D PRICE
Title or Position: MD, OWNER
Credential: MD
Phone: 334-222-4327