Healthcare Provider Details

I. General information

NPI: 1275474363
Provider Name (Legal Business Name): ANNA UNIVERSITY AT COKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALKER BLDG 2316, 362 THACH CONCOURSE
AUBURN AL
36849-0001
US

IV. Provider business mailing address

2316 WALKER BUILDING
AUBURN UNIVERSITY AL
36849-0001
US

V. Phone/Fax

Practice location:
  • Phone: 334-844-8348
  • Fax:
Mailing address:
  • Phone: 334-844-8348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberS14613
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: