Healthcare Provider Details

I. General information

NPI: 1871795625
Provider Name (Legal Business Name): COLON & RECTAL SURGERY CLINIC, P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 SPRING HILL AVE
MOBILE AL
36604-1402
US

IV. Provider business mailing address

1733 SPRING HILL AVE
MOBILE AL
36604-1402
US

V. Phone/Fax

Practice location:
  • Phone: 251-433-2265
  • Fax: 251-433-1209
Mailing address:
  • Phone: 251-433-2265
  • Fax: 251-433-1209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number00005635
License Number StateAL

VIII. Authorized Official

Name: DR. DONALD WAYNE HOLLENSWORTH
Title or Position: PRESIDENT
Credential: MD
Phone: 251-433-2265