Healthcare Provider Details

I. General information

NPI: 1134805708
Provider Name (Legal Business Name): MARY WOFFORD AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 WILLIAMS AVE SW STE 1111
HUNTSVILLE AL
35801-6087
US

IV. Provider business mailing address

2061 LAKEWOOD DR
VESTAVIA HILLS AL
35216-1915
US

V. Phone/Fax

Practice location:
  • Phone: 256-536-7405
  • Fax:
Mailing address:
  • Phone: 205-305-3366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1344A
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: