Healthcare Provider Details

I. General information

NPI: 1477201416
Provider Name (Legal Business Name): DEMARA PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 03/17/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 MCCALEP-MCINTOSH HALL ALABAMA AGRICULTURAL & MECHANICAL UNIVERSITY
NORMAL AL
35762
US

IV. Provider business mailing address

107 MCCALEP-MCINTOSH HALL ALABAMA AGRICULTURAL & MECHANICAL UNIVERSITY
NORMAL AL
35762
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: