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General NPI Number Information
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NPI Number | 1235642893
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Entity Type | Organization
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Legal Business Name | SECD ATHENS
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Dates
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Enumeration Date | 11/06/2017
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Last Update Date | 11/06/2017
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Provider Practice Location Address
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Address Line | 22051 HWY 72 EAST F
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City | ATHENS
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State | AL
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Zip | 35613-3561
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Country | US
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Telephone | 256-262-0600
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Fax | 256-233-8499
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Provider Business Mailing Address
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Address Line | 4320 MONTEVALLO RD
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City | MOUNTAIN BRK
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State | AL
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Zip | 35213-2722
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Country | US
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Telephone | 205-434-7115
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Fax |
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Authorized Official
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Title or Position | REGIONAL DIRECTOR
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Name | HEATHER BRITTANY MCDONALD
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Credential |
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Telephone | 205-434-7115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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