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General NPI Number Information
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NPI Number | 1376768556
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Entity Type | Organization
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Legal Business Name | THE WAY LLC
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Dates
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Enumeration Date | 04/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1023 MEDICAL CENTER PKWY STE 310
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City | SELMA
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State | AL
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Zip | 36701-7740
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Country | US
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Telephone | 334-877-3617
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Fax | 334-877-3497
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Provider Business Mailing Address
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Address Line | 1023 MEDICAL CENTER PKWY STE 310
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City | SELMA
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State | AL
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Zip | 36701-7740
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Country | US
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Telephone | 334-877-3617
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Fax | 334-877-3497
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Authorized Official
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Title or Position | DOCTOR
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Name | MR. TIMOTHY MARLOW
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Credential | M.D.
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Telephone | 334-877-3617
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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 | 0012300
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License Number State | AL
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