Healthcare Provider Details

I. General information

NPI: 1457308512
Provider Name (Legal Business Name): GBR,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 MCFARLAND BLVD N
TUSCALOOSA AL
35406-2138
US

IV. Provider business mailing address

1850 MCFARLAND BLVD N
TUSCALOOSA AL
35406-2138
US

V. Phone/Fax

Practice location:
  • Phone: 205-556-5541
  • Fax: 205-554-7937
Mailing address:
  • Phone: 205-556-5541
  • Fax: 205-554-7937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number StateAL

VIII. Authorized Official

Name: DR. DIRK LANDON BERRY
Title or Position: CO-OWNER
Credential: M.D.
Phone: 205-556-5541