Healthcare Provider Details

I. General information

NPI: 1235123407
Provider Name (Legal Business Name): JAY THOMAS POHL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 MYNATT STREET SUITE E
HARTSELLE AL
35640
US

IV. Provider business mailing address

615 MYNATT STREET SUITE E
HARTSELLE AL
35640
US

V. Phone/Fax

Practice location:
  • Phone: 256-773-2979
  • Fax: 256-773-2986
Mailing address:
  • Phone: 256-773-2979
  • Fax: 256-773-2986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number00019023
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: