Healthcare Provider Details

I. General information

NPI: 1912377508
Provider Name (Legal Business Name): ALLY RADIOLOGY CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2015
Last Update Date: 09/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 W FARMVILLE RD
AUBURN AL
36879-4621
US

IV. Provider business mailing address

1907 W FARMVILLE RD
AUBURN AL
36879-4621
US

V. Phone/Fax

Practice location:
  • Phone: 205-422-3424
  • Fax: 334-384-9274
Mailing address:
  • Phone: 205-422-3424
  • Fax: 334-384-9274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberMD.29612
License Number StateAL

VIII. Authorized Official

Name: DR. JASON ANDREW HOOVER
Title or Position: OWNER/CEO
Credential: M.D.
Phone: 205-422-3424