Healthcare Provider Details

I. General information

NPI: 1639082019
Provider Name (Legal Business Name): DONNA MOORE HANNUM CPC, CRC, CBEC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 OFFICE PARK DR STE 290
MOUNTAIN BRK AL
35223-3100
US

IV. Provider business mailing address

402 OFFICE PARK DR STE 290
MOUNTAIN BRK AL
35223-3100
US

V. Phone/Fax

Practice location:
  • Phone: 205-918-6161
  • Fax:
Mailing address:
  • Phone: 205-918-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: