Healthcare Provider Details

I. General information

NPI: 1457150849
Provider Name (Legal Business Name): AMY CORWIN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7475 HALCYON POINTE DR
MONTGOMERY AL
36117-8053
US

IV. Provider business mailing address

7475 HALCYON POINTE DR
MONTGOMERY AL
36117-8053
US

V. Phone/Fax

Practice location:
  • Phone: 334-954-6010
  • Fax: 334-649-6399
Mailing address:
  • Phone: 334-954-6010
  • Fax: 334-649-6399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6058C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: