Healthcare Provider Details

I. General information

NPI: 1437851599
Provider Name (Legal Business Name): MASYN AINSWORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6720 GRELOT RD STE A
MOBILE AL
36695-2676
US

IV. Provider business mailing address

6720 GRELOT RD STE A
MOBILE AL
36695-2676
US

V. Phone/Fax

Practice location:
  • Phone: 251-633-5155
  • Fax: 251-633-5125
Mailing address:
  • Phone: 251-633-5155
  • Fax: 251-633-5125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: