Healthcare Provider Details

I. General information

NPI: 1356818090
Provider Name (Legal Business Name): MEDPLEX, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2018
Last Update Date: 10/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 4TH AVE S
BIRMINGHAM AL
35233-2204
US

IV. Provider business mailing address

2124 4TH AVE S
BIRMINGHAM AL
35233-2204
US

V. Phone/Fax

Practice location:
  • Phone: 205-731-9090
  • Fax: 205-731-0760
Mailing address:
  • Phone: 205-731-9090
  • Fax: 205-731-0760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: EMILY LAZENBY
Title or Position: PHYSICIAN OWNER
Credential: M.D.
Phone: 205-731-9090