Healthcare Provider Details

I. General information

NPI: 1033449376
Provider Name (Legal Business Name): VACCINATION SERVICES OF ALABAMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 HILLFLO AVE
OPELIKA AL
36801-2206
US

IV. Provider business mailing address

804 HILLFLO AVE
OPELIKA AL
36801-2206
US

V. Phone/Fax

Practice location:
  • Phone: 334-319-3279
  • Fax:
Mailing address:
  • Phone: 334-319-3279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1086070
License Number StateAL

VIII. Authorized Official

Name: MR. GARY A WOOD
Title or Position: OWNER
Credential: CRNA
Phone: 334-319-3279