Healthcare Provider Details

I. General information

NPI: 1770026619
Provider Name (Legal Business Name): PAYNE AND HOLLOWAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2016
Last Update Date: 11/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7006 FULTON CT
MONTGOMERY AL
36117-8022
US

IV. Provider business mailing address

687 TIMBERLANE RD
PIKE ROAD AL
36064-2231
US

V. Phone/Fax

Practice location:
  • Phone: 334-244-7209
  • Fax: 334-244-6604
Mailing address:
  • Phone: 334-244-7209
  • Fax: 334-244-6604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8318
License Number StateAL

VIII. Authorized Official

Name: DR. ALBERT Z HOLLOWAY
Title or Position: OWNER
Credential: MD
Phone: 334-244-7209