Healthcare Provider Details

I. General information

NPI: 1760446876
Provider Name (Legal Business Name): BHC - JEMISON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25420 US HIGHWAY 31
JEMISON AL
35085-7868
US

IV. Provider business mailing address

25420 US HIGHWAY 31
JEMISON AL
35085-7868
US

V. Phone/Fax

Practice location:
  • Phone: 205-668-1616
  • Fax: 205-668-1038
Mailing address:
  • Phone: 205-668-1616
  • Fax: 205-668-1038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VALETA D NEAL
Title or Position: PRESIDENT
Credential:
Phone: 205-715-5901