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General NPI Number Information
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NPI Number | 1336653393
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Entity Type | Organization
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Legal Business Name | WOMEN'S PREMIER OB-GYN, LLC
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Dates
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Enumeration Date | 11/28/2017
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Last Update Date | 11/28/2017
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Provider Practice Location Address
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Address Line | 619 E LAUREL AVE
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City | FOLEY
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State | AL
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Zip | 36535-3301
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Country | US
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Telephone | 251-300-2418
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Fax | 251-471-5597
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Provider Business Mailing Address
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Address Line | 619 E LAUREL AVE
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City | FOLEY
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State | AL
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Zip | 36535-3301
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Country | US
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Telephone | 251-300-2418
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Fax | 251-471-5597
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Authorized Official
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Title or Position | OWNER
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Name | COREY D JACOBS
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Credential | MD
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Telephone | 251-300-2418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 27305
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License Number State | AL
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