Healthcare Provider Details

I. General information

NPI: 1306448394
Provider Name (Legal Business Name): NORTHWEST ALABAMA PSYCHIATRIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MEDICAL CENTER DR STE 300
JASPER AL
35501-3428
US

IV. Provider business mailing address

20 MEDICAL CENTER DR STE 300
JASPER AL
35501-3428
US

V. Phone/Fax

Practice location:
  • Phone: 205-384-0141
  • Fax: 205-384-0171
Mailing address:
  • Phone: 205-384-0141
  • Fax: 205-384-0171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: TERRY WAYNE BENTLEY
Title or Position: OWNER/PSYCHIATRIST
Credential:
Phone: 205-384-0141