Healthcare Provider Details

I. General information

NPI: 1831249283
Provider Name (Legal Business Name): HEALTHCARE AUTHORITY OF ELBA, AL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

978 DRAYTON AVE
ELBA AL
36323-1404
US

IV. Provider business mailing address

978 DRAYTON AVE
ELBA AL
36323-1404
US

V. Phone/Fax

Practice location:
  • Phone: 334-897-2597
  • Fax: 334-897-6662
Mailing address:
  • Phone: 334-897-2597
  • Fax: 334-897-6662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO314
License Number StateAL

VIII. Authorized Official

Name: ELLEN C. BRILEY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: RN
Phone: 334-897-2257