Healthcare Provider Details

I. General information

NPI: 1093385379
Provider Name (Legal Business Name): ALABAMA AGRICULTURE AND MECHANICAL UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 MERIDIAN ST NW
NORMAL AL
35762-7500
US

IV. Provider business mailing address

4900 MERIDIAN ST NW
NORMAL AL
35762-7500
US

V. Phone/Fax

Practice location:
  • Phone: 256-583-3696
  • Fax:
Mailing address:
  • Phone: 256-583-3696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ERNST CEBERT
Title or Position: PROFESSOR
Credential: PHD
Phone: 256-929-2036