Healthcare Provider Details

I. General information

NPI: 1720477995
Provider Name (Legal Business Name): RICHARD JUSTIN BATES NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 HIGHWAY 78 E
JASPER AL
35501-3430
US

IV. Provider business mailing address

2708 HIGHWAY 78 E
JASPER AL
35501-3430
US

V. Phone/Fax

Practice location:
  • Phone: 205-387-2253
  • Fax: 205-387-2269
Mailing address:
  • Phone: 205-387-2253
  • Fax: 205-387-2269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-117933
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: