Healthcare Provider Details

I. General information

NPI: 1699331165
Provider Name (Legal Business Name): AMANDA BETH ALLDREDGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9431 AL HIGHWAY 22
MAPLESVILLE AL
36750-3264
US

IV. Provider business mailing address

405 BELCHER ST
CENTREVILLE AL
35042-2946
US

V. Phone/Fax

Practice location:
  • Phone: 334-366-4040
  • Fax: 334-366-4262
Mailing address:
  • Phone: 205-926-2992
  • Fax: 205-316-7675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.44530
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: