Healthcare Provider Details

I. General information

NPI: 1841475902
Provider Name (Legal Business Name): HELENA'S FAMILY DOCTOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 07/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 2ND ST
HELENA AL
35080-3209
US

IV. Provider business mailing address

775 2ND ST
HELENA AL
35080-3209
US

V. Phone/Fax

Practice location:
  • Phone: 205-664-9990
  • Fax: 205-664-8882
Mailing address:
  • Phone: 205-664-9990
  • Fax: 205-664-8882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17215
License Number StateAL

VIII. Authorized Official

Name: DR. DAVID BURTON AIZENMAN
Title or Position: OWNER/SOLO PRACTITIONER
Credential: M.D.
Phone: 205-664-9990