Healthcare Provider Details

I. General information

NPI: 1992967772
Provider Name (Legal Business Name): MARSHALL MEDICAL CENTER SOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 US HWY 431 N
BOAZ AL
35957
US

IV. Provider business mailing address

2505 US HWY 431 N
BOAZ AL
35957
US

V. Phone/Fax

Practice location:
  • Phone: 256-593-8310
  • Fax:
Mailing address:
  • Phone: 256-593-8310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateAL

VIII. Authorized Official

Name: MS. KATHY B NELSON
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 256-894-6600