Healthcare Provider Details

I. General information

NPI: 1740567486
Provider Name (Legal Business Name): MELVIN D THORNBURY JR MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 US HIGHWAY 431 SUITE 220
BOAZ AL
35957-5934
US

IV. Provider business mailing address

2525 US HIGHWAY 431 SUITE 220
BOAZ AL
35957-5967
US

V. Phone/Fax

Practice location:
  • Phone: 256-840-4520
  • Fax: 256-840-4527
Mailing address:
  • Phone: 256-840-4520
  • Fax: 256-840-4527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number14828
License Number StateAL

VIII. Authorized Official

Name: DR. MELVIN DELAINE THORNBURY JR.
Title or Position: M.D.
Credential: M.D.
Phone: 256-840-4520