Healthcare Provider Details

I. General information

NPI: 1972553204
Provider Name (Legal Business Name): NORTHWEST ALABAMA CANCER CENTER RADIOLOGICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 W DR HICKS BLVD STE. B
FLORENCE AL
35630-6160
US

IV. Provider business mailing address

101 DR W H BLAKE JR DR
MUSCLE SHOALS AL
35661-2152
US

V. Phone/Fax

Practice location:
  • Phone: 256-767-2733
  • Fax: 256-767-2717
Mailing address:
  • Phone: 256-381-1001
  • Fax: 256-381-3604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number1359
License Number StateAL

VIII. Authorized Official

Name: DR. J. PATRICK DAUGHERTY
Title or Position: PRESIDENT
Credential: MD
Phone: 256-764-4200