Healthcare Provider Details

I. General information

NPI: 1609933514
Provider Name (Legal Business Name): LADIGA MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 11/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 2ND AVE SW # A
JACKSONVILLE AL
36265-3358
US

IV. Provider business mailing address

1460 A SECOND AVE SW
JACKSONVILLE AL
36265
US

V. Phone/Fax

Practice location:
  • Phone: 256-435-2180
  • Fax: 256-435-9525
Mailing address:
  • Phone: 256-435-2180
  • Fax: 256-435-9525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number9644
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number7858
License Number StateAL

VIII. Authorized Official

Name: PENNY E NEWTON
Title or Position: OFFICE MANAGER
Credential:
Phone: 256-435-2180