Healthcare Provider Details

I. General information

NPI: 1013202951
Provider Name (Legal Business Name): VETERANS ADMINISTRATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 06/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GOVERNORS DR SW
HUNTSVILLE AL
35801-5123
US

IV. Provider business mailing address

1205 9TH ST NE
JACKSONVILLE AL
36265-1207
US

V. Phone/Fax

Practice location:
  • Phone: 256-535-3100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number2732G
License Number StateAL

VIII. Authorized Official

Name: MRS. AUDRY SMITH
Title or Position: COORDINATOR FOR MHICM PROGRAMS
Credential: MSN, PMHNP
Phone: 205-933-8101