Healthcare Provider Details

I. General information

NPI: 1447868757
Provider Name (Legal Business Name): ADVENT HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 SLAUGHTER RD STE C
MADISON AL
35758-5901
US

IV. Provider business mailing address

1230 SLAUGHTER RD STE C
MADISON AL
35758-5901
US

V. Phone/Fax

Practice location:
  • Phone: 256-325-0955
  • Fax:
Mailing address:
  • Phone: 256-325-0955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BLAKE HAMILTON GILLIAM
Title or Position: CRNP
Credential: CRNP
Phone: 256-325-0955