Healthcare Provider Details

I. General information

NPI: 1962319061
Provider Name (Legal Business Name): GRACIE BOSARGE EMLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 N UNIVERSITY BLVD
MOBILE AL
36608-3074
US

IV. Provider business mailing address

6450 FAIROAK DR S
MOBILE AL
36619-1515
US

V. Phone/Fax

Practice location:
  • Phone: 251-460-6101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number1-195151
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: