Healthcare Provider Details

I. General information

NPI: 1104922368
Provider Name (Legal Business Name): HALEYVILLE MEDICAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42320 HWY 195
HALEYVILLE AL
35565-7015
US

IV. Provider business mailing address

42320 HWY 195
HALEYVILLE AL
35565-7015
US

V. Phone/Fax

Practice location:
  • Phone: 205-486-8899
  • Fax: 205-486-8908
Mailing address:
  • Phone: 205-486-8899
  • Fax: 205-486-8908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VIJAYA V REDDY
Title or Position: PRACTICE MANAGER
Credential: CPC, BA
Phone: 205-486-8899