Healthcare Provider Details

I. General information

NPI: 1124257209
Provider Name (Legal Business Name): WOMENS HEALTHCARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 07/09/2009
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: 334-222-1583
  • Fax: 334-222-1573
Mailing address:
  • Phone: 334-222-1583
  • Fax: 334-222-1573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDO833
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1061816
License Number StateAL

VIII. Authorized Official

Name: MS. STELLA L. VINSON
Title or Position: NP/PRESIDENT
Credential: NP
Phone: 334-222-1583