Healthcare Provider Details

I. General information

NPI: 1417997842
Provider Name (Legal Business Name): ROY GANDY MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 HAND AVE SUITE 4
BAY MINETTE AL
36507-4191
US

IV. Provider business mailing address

2305 HAND AVE SUITE 4
BAY MINETTE AL
36507-4191
US

V. Phone/Fax

Practice location:
  • Phone: 251-580-4600
  • Fax: 251-580-4160
Mailing address:
  • Phone: 251-580-4600
  • Fax: 251-580-4160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number6662
License Number StateAL

VIII. Authorized Official

Name: DR. ROY EDWARD GANDY
Title or Position: PRESIDENT
Credential: MD
Phone: 251-580-4600