Healthcare Provider Details

I. General information

NPI: 1578183190
Provider Name (Legal Business Name): ALLEGRA HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 MITT LARY RD
NORTHPORT AL
35475-4978
US

IV. Provider business mailing address

1116 MITT LARY RD
NORTHPORT AL
35475-4978
US

V. Phone/Fax

Practice location:
  • Phone: 205-556-5634
  • Fax: 205-556-5644
Mailing address:
  • Phone: 205-556-5634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMY MCMURRY SHIRLEY
Title or Position: VICE-PRESIDENT
Credential: CRNP
Phone: 205-556-5634