Healthcare Provider Details

I. General information

NPI: 1023587540
Provider Name (Legal Business Name): BETHANY JOY SANDLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 MEMORIAL PKWY SW
HUNTSVILLE AL
35802-4364
US

IV. Provider business mailing address

4040 MEMORIAL PKWY SW
HUNTSVILLE AL
35802-4364
US

V. Phone/Fax

Practice location:
  • Phone: 256-533-1970
  • Fax: 256-532-4112
Mailing address:
  • Phone: 256-533-1970
  • Fax: 256-532-4112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: