Healthcare Provider Details

I. General information

NPI: 1285409557
Provider Name (Legal Business Name): CILINICAL UROLOGY ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 GLENN BLVD SW
FORT PAYNE AL
35968-3527
US

IV. Provider business mailing address

713 GOODYEAR AVE
GADSDEN AL
35903-1156
US

V. Phone/Fax

Practice location:
  • Phone: 256-492-4040
  • Fax: 256-492-4017
Mailing address:
  • Phone: 256-492-4040
  • Fax: 256-492-4017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: KOURTNEY MAYO
Title or Position: CREDENTIALING
Credential:
Phone: 256-492-4040