Healthcare Provider Details

I. General information

NPI: 1437109691
Provider Name (Legal Business Name): GARY E. CARNAHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 CENTER ST
MOBILE AL
36604-3301
US

IV. Provider business mailing address

PO BOX 40480
MOBILE AL
36640-0480
US

V. Phone/Fax

Practice location:
  • Phone: 251-415-1612
  • Fax: 251-415-1003
Mailing address:
  • Phone: 251-471-7790
  • Fax: 251-741-7715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number19540
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: