Healthcare Provider Details

I. General information

NPI: 1285962738
Provider Name (Legal Business Name): GREATER ALABAMA HEALTH NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 PROFESSIONAL PLZ
TUSCALOOSA AL
35401-7418
US

IV. Provider business mailing address

921 PROFESSIONAL PLZ
TUSCALOOSA AL
35401-7418
US

V. Phone/Fax

Practice location:
  • Phone: 205-345-1905
  • Fax: 205-345-2909
Mailing address:
  • Phone: 205-345-1905
  • Fax: 205-345-2909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MRS. BECKY HENDERSON
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 205-345-1905