Healthcare Provider Details

I. General information

NPI: 1104865021
Provider Name (Legal Business Name): THE CENTER FOR COLON AND DIGESTIVE DISEASE P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 LONGWOOD DRIVE
HUNTSVILLE AL
35801
US

IV. Provider business mailing address

PO BOX 2324
BIRMINGHAM AL
35201-2324
US

V. Phone/Fax

Practice location:
  • Phone: 256-533-6488
  • Fax: 256-533-6495
Mailing address:
  • Phone: 256-533-7064
  • Fax: 256-704-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL W BROWN
Title or Position: PRESIDENT
Credential: MD
Phone: 256-533-6488