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General NPI Number Information
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NPI Number | 1083764526
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Entity Type | Organization
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Legal Business Name | ANNISTON GASTROENTEROLOGY ASSOCIATES
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 04/21/2009
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Provider Practice Location Address
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Address Line | 1720 LEIGHTON AVE
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City | ANNISTON
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State | AL
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Zip | 36207-3811
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Country | US
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Telephone | 256-237-3284
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Fax | 256-237-4104
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Provider Business Mailing Address
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Address Line | PO BOX 126
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City | ANNISTON
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State | AL
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Zip | 36202-0126
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Country | US
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Telephone | 256-237-3284
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Fax | 256-237-4104
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | HOLLY BENEFIELD
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Credential |
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Telephone | 256-237-3284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 19468
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License Number State | AL
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