Healthcare Provider Details

I. General information

NPI: 1982255675
Provider Name (Legal Business Name): ANNA LOCKHART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28921 HIGHWAY 5
WOODSTOCK AL
35188-3613
US

IV. Provider business mailing address

405 BELCHER ST
CENTREVILLE AL
35042-2946
US

V. Phone/Fax

Practice location:
  • Phone: 205-938-9348
  • Fax: 205-938-9020
Mailing address:
  • Phone: 205-926-2992
  • Fax: 205-316-7675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-137519
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: