Healthcare Provider Details

I. General information

NPI: 1992973408
Provider Name (Legal Business Name): ALABAMA ORTHOPAEDICS AND SPORTS MEDICINE ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 WINTON M BLOUNT LOOP
MONTGOMERY AL
36117-3501
US

IV. Provider business mailing address

242 WINTON M BLOUNT LOOP
MONTGOMERY AL
36117-3501
US

V. Phone/Fax

Practice location:
  • Phone: 334-395-5800
  • Fax: 334-395-5880
Mailing address:
  • Phone: 334-395-5800
  • Fax: 334-395-5880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number00008637
License Number StateAL

VIII. Authorized Official

Name: MRS. DEBBIE JEAN HARKNESS
Title or Position: ADMINISTRATOR
Credential:
Phone: 334-395-5800