Healthcare Provider Details

I. General information

NPI: 1124108535
Provider Name (Legal Business Name): CENTRAL ALABAMA ENT ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 11/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6980 WINTON BLOUNT BLVD
MONTGOMERY AL
36117-3556
US

IV. Provider business mailing address

6980 WINTON BLOUNT BLVD
MONTGOMERY AL
36117-3556
US

V. Phone/Fax

Practice location:
  • Phone: 334-277-0484
  • Fax: 334-272-8877
Mailing address:
  • Phone: 334-277-0484
  • Fax: 334-272-8877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: WALLACE CARROLL VAUGHAN JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 334-277-0484