Healthcare Provider Details

I. General information

NPI: 1679007157
Provider Name (Legal Business Name): BENJAMIN NUNLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 LONGWOOD DR SW
HUNTSVILLE AL
35801-4522
US

IV. Provider business mailing address

PO BOX 280
HARVEST AL
35749-0280
US

V. Phone/Fax

Practice location:
  • Phone: 256-533-6488
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number37726
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: