Healthcare Provider Details

I. General information

NPI: 1588378475
Provider Name (Legal Business Name): WEST ALABAMA AIDS OUTREACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3052 MCGEHEE RD
MONTGOMERY AL
36111-2203
US

IV. Provider business mailing address

3052 MCGEHEE RD
MONTGOMERY AL
36111-2203
US

V. Phone/Fax

Practice location:
  • Phone: 334-280-3349
  • Fax:
Mailing address:
  • Phone: 334-280-3349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: BILLY DANIEL KIRKPATRICK
Title or Position: CEO
Credential:
Phone: 205-759-8470