Healthcare Provider Details

I. General information

NPI: 1295905511
Provider Name (Legal Business Name): STATE OF ALABAMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 HIGHWAY 5 S
MARION AL
36756-3413
US

IV. Provider business mailing address

50 N RIPLEY ST FAMILY SERVICES DIVISION
MONTGOMERY AL
36130-1001
US

V. Phone/Fax

Practice location:
  • Phone: 334-683-5500
  • Fax: 334-683-9799
Mailing address:
  • Phone: 334-242-1310
  • Fax: 334-242-0198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. PARRIS L CORLEY
Title or Position: DEPUTY COMMISSIONER FISCAL & ADMIN
Credential:
Phone: 334-242-8395