Healthcare Provider Details

I. General information

NPI: 1346207131
Provider Name (Legal Business Name): CHARLES HENDERSON MEMORIAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 HIGHWAY 231 S
TROY AL
36081-3058
US

IV. Provider business mailing address

PO BOX 928
TROY AL
36081-0928
US

V. Phone/Fax

Practice location:
  • Phone: 334-566-7600
  • Fax: 334-566-1445
Mailing address:
  • Phone: 334-566-7600
  • Fax: 334-566-1445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JERRI B SMITH
Title or Position: FINANCIAL MANAGER
Credential:
Phone: 334-566-7600