Healthcare Provider Details

I. General information

NPI: 1629452123
Provider Name (Legal Business Name): PRESTIGE MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

857 DOWNTOWNER BLVD STE G
MOBILE AL
36609-5420
US

IV. Provider business mailing address

103 S NAVY BLVD
PENSACOLA FL
32507-3603
US

V. Phone/Fax

Practice location:
  • Phone: 251-341-7295
  • Fax: 251-341-7690
Mailing address:
  • Phone: 850-361-1502
  • Fax: 850-361-1503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN NORRIS
Title or Position: OWNER
Credential:
Phone: 251-341-7295