Healthcare Provider Details

I. General information

NPI: 1316988199
Provider Name (Legal Business Name): ANITRA D. BATIE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 HIGHWAY 78 E MEDICAL ARTS TOWER; SUITE 110
JASPER AL
35501-8907
US

IV. Provider business mailing address

3400 HIGHWAY 78 E MEDICAL ARTS TOWER; SUITE 110
JASPER AL
35501-8907
US

V. Phone/Fax

Practice location:
  • Phone: 205-221-1755
  • Fax: 205-221-9961
Mailing address:
  • Phone: 205-221-1755
  • Fax: 205-221-9961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25536
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: