Healthcare Provider Details

I. General information

NPI: 1669882858
Provider Name (Legal Business Name): BERNITA MCCANTS MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 04/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 E PUSHMATAHA ST
BUTLER AL
36904-2728
US

IV. Provider business mailing address

603 RACHEL CT
BAY MINETTE AL
36507-4190
US

V. Phone/Fax

Practice location:
  • Phone: 205-459-5506
  • Fax: 205-459-5503
Mailing address:
  • Phone: 251-753-2227
  • Fax: 251-937-7559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28458
License Number StateAL

VIII. Authorized Official

Name: DR. BERNITA F MIMS
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 251-753-2227