Healthcare Provider Details

I. General information

NPI: 1841359221
Provider Name (Legal Business Name): CANDACE L PERRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 04/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 ROPER LN
DAPHNE AL
36526-5274
US

IV. Provider business mailing address

5750A SOUTHLAND DR
MOBILE AL
36693-3316
US

V. Phone/Fax

Practice location:
  • Phone: 251-378-6500
  • Fax:
Mailing address:
  • Phone: 251-661-0153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20970
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number46644
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: