Healthcare Provider Details

I. General information

NPI: 1902417520
Provider Name (Legal Business Name): JAMES KELLEY GUNN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 MOBILE INFIRMARY BLVD
MOBILE AL
36607-3510
US

IV. Provider business mailing address

168 MOBILE INFIRMARY BLVD
MOBILE AL
36607-3510
US

V. Phone/Fax

Practice location:
  • Phone: 251-433-1895
  • Fax:
Mailing address:
  • Phone: 251-752-0091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1828
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: