Healthcare Provider Details

I. General information

NPI: 1134995095
Provider Name (Legal Business Name): BAY AREA CLARITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 11/30/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25369 HWY 98 SUITE D-2
DAPHNE AL
36526
US

IV. Provider business mailing address

120 GLEN HARDIE DR
FAIRHOPE AL
36532-3049
US

V. Phone/Fax

Practice location:
  • Phone: 251-999-0102
  • Fax:
Mailing address:
  • Phone: 205-492-0126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MEGAN E DESHAZO
Title or Position: MANAGER
Credential: MD
Phone: 205-492-0126