Healthcare Provider Details

I. General information

NPI: 1952724965
Provider Name (Legal Business Name): JAMES MCGOUGH CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 WINTON M BLOUNT LOOP
MONTGOMERY AL
36117-3507
US

IV. Provider business mailing address

PO BOX 241587
MONTGOMERY AL
36124-1587
US

V. Phone/Fax

Practice location:
  • Phone: 334-280-1500
  • Fax: 334-280-1600
Mailing address:
  • Phone: 334-280-1511
  • Fax: 334-280-1611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-122756
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: