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General NPI Number Information
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NPI Number | 1295883031
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Entity Type | Individual
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Provider Name | AMANDA LARA STOREY MD
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Gender | Female
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 11/06/2017
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Provider Practice Location Address
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Address Line | 4500 MAIN ST
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City | GRANT
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State | AL
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Zip | 35747-8303
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Country | US
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Telephone | 256-728-8600
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Fax | 256-728-8602
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Provider Business Mailing Address
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Address Line | PO BOX 11407 DEPT# 0132
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City | BIRMINGHAM
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State | AL
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Zip | 35246-0132
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Country | US
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Telephone | 256-728-8600
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Fax | 256-728-8602
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 32410
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License Number State | AL
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