Healthcare Provider Details

I. General information

NPI: 1447222112
Provider Name (Legal Business Name): WILLIAM H. MCDONALD ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 PAUL BRYANT DR. BOX 870323
TUSCALOOSA AL
35487-0001
US

IV. Provider business mailing address

12289 LESTER TAYLOR RD
NORTHPORT AL
35475-2721
US

V. Phone/Fax

Practice location:
  • Phone: 205-348-3651
  • Fax: 205-348-9932
Mailing address:
  • Phone: 205-339-6490
  • Fax: 205-348-9932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number172A00000X
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: