Healthcare Provider Details

I. General information

NPI: 1831360601
Provider Name (Legal Business Name): DECATUR MAXILLOFACIAL & COSMETIC SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2023 DANVILLE PARK DR SW
DECATUR AL
35603-1833
US

IV. Provider business mailing address

2023 DANVILLE PARK DR SW
DECATUR AL
35603-1833
US

V. Phone/Fax

Practice location:
  • Phone: 256-355-8224
  • Fax: 256-355-8819
Mailing address:
  • Phone: 256-355-8224
  • Fax: 256-355-8819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM F LITTLEJOHN JR.
Title or Position: PRESIDENT
Credential: DMD, MD
Phone: 256-355-8224