Healthcare Provider Details

I. General information

NPI: 1295234722
Provider Name (Legal Business Name): VIGILANT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2018
Last Update Date: 07/02/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 OBRANNAN PARK DR
DOTHAN AL
36303
US

IV. Provider business mailing address

PO BOX 660257
BIRMINGHAM AL
35266-0257
US

V. Phone/Fax

Practice location:
  • Phone: 334-769-4669
  • Fax:
Mailing address:
  • Phone: 205-979-5882
  • Fax: 205-979-1248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateAL

VIII. Authorized Official

Name: STEPHEN GUY HARRELL
Title or Position: OWNER
Credential: CRNA
Phone: 334-798-1816