Healthcare Provider Details

I. General information

NPI: 1033773270
Provider Name (Legal Business Name): RENEE CHERIAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 GRASSELLI RD
FAIRFIELD AL
35064-2424
US

IV. Provider business mailing address

405 BELCHER ST
CENTREVILLE AL
35042-2946
US

V. Phone/Fax

Practice location:
  • Phone: 205-791-5048
  • Fax: 205-558-8045
Mailing address:
  • Phone: 205-926-2992
  • Fax: 205-316-7675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO.2924
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: