Healthcare Provider Details

I. General information

NPI: 1326415175
Provider Name (Legal Business Name): AUBURN UNIVERSITY AT MONTGOMERY STUDENT HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2015
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7461 EAST DRIVE
MONTGOMERY AL
36117
US

IV. Provider business mailing address

PO BOX 244023
MONTGOMERY AL
36124-4023
US

V. Phone/Fax

Practice location:
  • Phone: 344-244-3281
  • Fax:
Mailing address:
  • Phone: 334-244-3281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number StateAL

VIII. Authorized Official

Name: CAROL STUART
Title or Position: DIRECTOR OF STUDENT HEALTH SERVICES
Credential: CRNP
Phone: 334-244-3281