Healthcare Provider Details

I. General information

NPI: 1720042963
Provider Name (Legal Business Name): BHC-BLOUNT & ETOWAH COUNTIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 GILBREATH DR SUITE 201
ONEONTA AL
35121-2827
US

IV. Provider business mailing address

PO BOX 830605
BIRMINGHAM AL
35283-0605
US

V. Phone/Fax

Practice location:
  • Phone: 205-274-8198
  • Fax: 205-274-8197
Mailing address:
  • Phone: 205-715-5943
  • Fax: 205-715-5932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GEORGE SCOTT FENN
Title or Position: CHIEF INTEGRATION OFFICER
Credential:
Phone: 205-715-5415