Healthcare Provider Details

I. General information

NPI: 1255599916
Provider Name (Legal Business Name): DENNIS CORRY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

693 COUNTY ROAD 1343
VINEMONT AL
35179-6191
US

IV. Provider business mailing address

PO BOX 305
VINEMONT AL
35179-0305
US

V. Phone/Fax

Practice location:
  • Phone: 256-739-2051
  • Fax: 256-775-1317
Mailing address:
  • Phone: 256-739-2051
  • Fax: 256-775-1317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number237199
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: