Healthcare Provider Details

I. General information

NPI: 1821827114
Provider Name (Legal Business Name): CHIGOZIE C CHIDEBELU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SUN TEMPLE DR
MADISON AL
35758-5919
US

IV. Provider business mailing address

300 SUN TEMPLE DR
MADISON AL
35758-5919
US

V. Phone/Fax

Practice location:
  • Phone: 256-325-9111
  • Fax: 256-325-9113
Mailing address:
  • Phone: 256-325-9111
  • Fax: 256-325-9113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number143479
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: