Healthcare Provider Details

I. General information

NPI: 1487739314
Provider Name (Legal Business Name): LOUIS KEITH GUINN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E PUSHMATAHA ST
BUTLER AL
36904-0678
US

IV. Provider business mailing address

315 E PUSHMATAHA ST P O BOX 678
BUTLER AL
36904-0678
US

V. Phone/Fax

Practice location:
  • Phone: 205-459-4499
  • Fax: 205-459-5348
Mailing address:
  • Phone: 205-459-4499
  • Fax: 205-459-5348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13769
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17028
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: