Healthcare Provider Details

I. General information

NPI: 1053405175
Provider Name (Legal Business Name): NORTHWEST ALABAMA MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 MEDICAL CLINIC DR
VERNON AL
35592-5232
US

IV. Provider business mailing address

245 MEDICAL CLINIC DR
VERNON AL
35592-5232
US

V. Phone/Fax

Practice location:
  • Phone: 205-695-7531
  • Fax: 205-695-9529
Mailing address:
  • Phone: 205-695-7531
  • Fax: 205-695-9529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. FLOYD FULTON NEWMAN SR.
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW
Phone: 205-302-9065