Healthcare Provider Details

I. General information

NPI: 1538326053
Provider Name (Legal Business Name): ALABAMA NURSING HOME FOOT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1788 MCFARLAND BLVD N SUITE B
TUSCALOOSA AL
35406-2190
US

IV. Provider business mailing address

1788 MCFARLAND BLVD N SUITE B
TUSCALOOSA AL
35406-2190
US

V. Phone/Fax

Practice location:
  • Phone: 205-759-9100
  • Fax: 205-759-1821
Mailing address:
  • Phone: 205-759-9100
  • Fax: 205-759-1821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number272
License Number StateAL

VIII. Authorized Official

Name: DR. BARRY J GOULD
Title or Position: PHYSICIAN
Credential: DPM
Phone: 205-759-9100