Healthcare Provider Details

I. General information

NPI: 1083763478
Provider Name (Legal Business Name): ANNISTON CARDIOLOGY ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 LEIGHTON AVE SUITE 201
ANNISTON AL
36207-5700
US

IV. Provider business mailing address

901 LEIGHTON AVE SUITE 201
ANNISTON AL
36207-5700
US

V. Phone/Fax

Practice location:
  • Phone: 256-236-5181
  • Fax:
Mailing address:
  • Phone: 256-236-5181
  • Fax: 256-237-6829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DENNIS BONNER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 256-236-5181