Healthcare Provider Details

I. General information

NPI: 1104108208
Provider Name (Legal Business Name): ATHENS LIMESTONE HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15024 E LIMESTONE RD STE F
HARVEST AL
35749-7264
US

IV. Provider business mailing address

15024 E LIMESTONE RD STE F
HARVEST AL
35749-7264
US

V. Phone/Fax

Practice location:
  • Phone: 256-262-0535
  • Fax:
Mailing address:
  • Phone: 256-262-0535
  • Fax: 256-262-0536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: SEBRINA B HOLT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 256-216-9648