Healthcare Provider Details

I. General information

NPI: 1518137694
Provider Name (Legal Business Name): COVINGTON GYNECOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MEDICAL PARK DRIVE
ANDALUSIA AL
36420
US

IV. Provider business mailing address

P O BOX 640 115 MEDICAL PARK DRIVE
ANDALUSIA AL
36420
US

V. Phone/Fax

Practice location:
  • Phone: 334-222-5781
  • Fax: 334-222-5794
Mailing address:
  • Phone: 334-222-5781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number7388
License Number StateAL

VIII. Authorized Official

Name: MICHAEL A. WELLS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 334-222-5781