Healthcare Provider Details
I. General information
NPI: 1063719425
Provider Name (Legal Business Name): MOBILITY METABOLISM & WELLNESS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 02/22/2011
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
4357 MIDMOST DR
MOBILE AL
36609-5505
US
IV. Provider business mailing address
4357 MIDMOST DR
MOBILE AL
36609-5505
US
V. Phone/Fax
- Phone: 251-345-0773
- Fax: 877-806-8642
- Phone: 251-345-0773
- Fax: 877-806-8642
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2081P2900X |
| Taxonomy | Pain Medicine (Physical Medicine & Rehabilitation) Physician |
| License Number | 24535 |
| License Number State | AL |
VIII. Authorized Official
Name: DR.
JAMES
M
CRUMB
Title or Position: PRESIDENT
Credential: M.D.
Phone: 251-345-0773