Healthcare Provider Details

I. General information

NPI: 1376457804
Provider Name (Legal Business Name): JEREMY J NORTH MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 SPARKMAN ST SW
HARTSELLE AL
35640-3120
US

IV. Provider business mailing address

1713 OLD FAIRWAY RD
HUNTSVILLE AL
35806-6463
US

V. Phone/Fax

Practice location:
  • Phone: 256-502-9582
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6561G-S
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: