Healthcare Provider Details

I. General information

NPI: 1487011086
Provider Name (Legal Business Name): TOMBIGBEE HEALTHCARE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 US HIGHWAY 80 E STE 215
DEMOPOLIS AL
36732-3605
US

IV. Provider business mailing address

105 US HIGHWAY 80 E STE 215
DEMOPOLIS AL
36732-3605
US

V. Phone/Fax

Practice location:
  • Phone: 334-287-2840
  • Fax: 334-287-2846
Mailing address:
  • Phone: 334-287-2840
  • Fax: 334-287-2846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DONNA SUE GANDY
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 334-287-2423