Healthcare Provider Details

I. General information

NPI: 1558103473
Provider Name (Legal Business Name): ELIZABETH MCCORMACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 HAMRIC DR E STE 103
OXFORD AL
36203-2174
US

IV. Provider business mailing address

540 MAHAFFEY RD
EASTABOGA AL
36260-5618
US

V. Phone/Fax

Practice location:
  • Phone: 256-241-3242
  • Fax:
Mailing address:
  • Phone: 256-419-8601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: