Healthcare Provider Details

I. General information

NPI: 1013160886
Provider Name (Legal Business Name): AUDWIN DARRELL HARWELL C.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2008
Last Update Date: 10/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 PERRY HILL RD
MONTGOMERY AL
36109-3725
US

IV. Provider business mailing address

215 PERRY HILL RD
MONTGOMERY AL
36109-3725
US

V. Phone/Fax

Practice location:
  • Phone: 334-260-4110
  • Fax: 334-260-4130
Mailing address:
  • Phone: 334-260-4110
  • Fax: 334-260-4130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number503
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: