Healthcare Provider Details

I. General information

NPI: 1821333535
Provider Name (Legal Business Name): BHC-GASTROENTEROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 MEDICAL PARK OFC PARK
TALLADEGA AL
35160-2213
US

IV. Provider business mailing address

203 MEDICAL PARK OFC PARK
TALLADEGA AL
35160-2213
US

V. Phone/Fax

Practice location:
  • Phone: 205-715-5943
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: GEORGE SCOTT FENN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 205-715-5415