=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386695500
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COGENT HEALTHCARE OF DECATUR, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2006
-----------------------------------------------------
Last Update Date | 03/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 809 UNIVERSITY BLVD E
-----------------------------------------------------
City | TUSCALOOSA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-759-7111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5410 MARYLAND WAY SUITE 300
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027-5064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-377-5670
-----------------------------------------------------
Fax | 615-377-1687
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | LAURA FALL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 253-682-6040
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------