Healthcare Provider Details

I. General information

NPI: 1326950254
Provider Name (Legal Business Name): ADERHOLT ENTERPRISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 SHADY LN
ATHENS AL
35613-2014
US

IV. Provider business mailing address

108 SHADY LN
ATHENS AL
35613-2014
US

V. Phone/Fax

Practice location:
  • Phone: 256-777-1278
  • Fax:
Mailing address:
  • Phone: 256-777-1278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. BRADY ADERHOLT
Title or Position: OWNER
Credential: CRNP
Phone: 256-777-1278