Healthcare Provider Details

I. General information

NPI: 1831146901
Provider Name (Legal Business Name): ELIZABETH R WEATHERFORD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 E AVALON AVE
TUSCUMBIA AL
35674-1773
US

IV. Provider business mailing address

PO BOX 298
FLORENCE AL
35631-0298
US

V. Phone/Fax

Practice location:
  • Phone: 256-381-4400
  • Fax: 256-381-4783
Mailing address:
  • Phone: 256-767-7494
  • Fax: 256-760-8432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number00015778
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: