Healthcare Provider Details

I. General information

NPI: 1790720910
Provider Name (Legal Business Name): WINFIELD OB/GYN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 CARAWAY DR SUITE A1
WINFIELD AL
35594-5067
US

IV. Provider business mailing address

191 CARAWAY DR SUITE A1
WINFIELD AL
35594-5067
US

V. Phone/Fax

Practice location:
  • Phone: 205-487-1203
  • Fax: 205-487-1205
Mailing address:
  • Phone: 205-487-1203
  • Fax: 205-487-1205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number12079
License Number StateAL

VIII. Authorized Official

Name: MRS. DEMIE P WEATHERLY
Title or Position: OFFICE MANAGER
Credential:
Phone: 205-487-1203