=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285226944
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOCUS MD 1019 LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2021
-----------------------------------------------------
Last Update Date | 04/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 802 SHONEY DR SW STE B
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35801-5435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-937-3500
-----------------------------------------------------
Fax | 256-937-3501
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 802 SHONEY DR SW STE B
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35801-5435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-937-3500
-----------------------------------------------------
Fax | 256-937-3501
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | EMILY LITTLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 205-968-1518
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------