Healthcare Provider Details

I. General information

NPI: 1497107023
Provider Name (Legal Business Name): ALICIA MCGEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2016
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 EAST RD
GORDO AL
35466-3201
US

IV. Provider business mailing address

360 EAST RD
GORDO AL
35466-3201
US

V. Phone/Fax

Practice location:
  • Phone: 205-523-2246
  • Fax:
Mailing address:
  • Phone: 205-523-2246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3579C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: