Healthcare Provider Details

I. General information

NPI: 1265663926
Provider Name (Legal Business Name): DCLH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2908 CENTRAL AVE
BIRMINGHAM AL
35209-2579
US

IV. Provider business mailing address

2908 CENTRAL AVE
BIRMINGHAM AL
35209-2579
US

V. Phone/Fax

Practice location:
  • Phone: 205-871-7332
  • Fax: 205-871-7336
Mailing address:
  • Phone: 205-871-7332
  • Fax: 205-871-7336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD.025680
License Number StateAL

VIII. Authorized Official

Name: DR. COREY L HARTMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 205-871-7332