Healthcare Provider Details

I. General information

NPI: 1194208389
Provider Name (Legal Business Name): PATHWAY HEALTHCARE ALABAMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 PROVIDENCE PARK DR E STE 125
MOBILE AL
36695-4614
US

IV. Provider business mailing address

580 PROVIDENCE PARK DR E STE 125
MOBILE AL
36695-4614
US

V. Phone/Fax

Practice location:
  • Phone: 251-219-9810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MCEARL
Title or Position: BUSINESS OFFICE
Credential:
Phone: 731-891-0708