Healthcare Provider Details

I. General information

NPI: 1659595478
Provider Name (Legal Business Name): JUANITA POLLARD BRISCOE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 PINE ST
MONTGOMERY AL
36106-1109
US

IV. Provider business mailing address

7656 VAUGHN RD #165
MONTGOMERY AL
36116-6625
US

V. Phone/Fax

Practice location:
  • Phone: 334-293-8008
  • Fax: 334-293-6916
Mailing address:
  • Phone: 334-293-8008
  • Fax: 334-293-6916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberM7161
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberM7161
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: