Healthcare Provider Details

I. General information

NPI: 1639797376
Provider Name (Legal Business Name): SAMUEL DAVID DREW SR. RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 PERRY HILL RD
MONTGOMERY AL
36109-3725
US

IV. Provider business mailing address

359 RIDGEVIEW DR
MILLBROOK AL
36054-1797
US

V. Phone/Fax

Practice location:
  • Phone: 251-751-4267
  • Fax:
Mailing address:
  • Phone: 251-751-4267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number294
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: