Healthcare Provider Details

I. General information

NPI: 1720832819
Provider Name (Legal Business Name): GABRIEL ERIAN MINIAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 FREDERICK RD STE 1
OPELIKA AL
36801-7127
US

IV. Provider business mailing address

3101 FREDERICK RD STE 1
OPELIKA AL
36801-7127
US

V. Phone/Fax

Practice location:
  • Phone: 334-954-6010
  • Fax: 334-649-6399
Mailing address:
  • Phone: 334-954-6010
  • Fax: 334-649-6399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1-195900
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1224220
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: