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General NPI Number Information
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NPI Number | 1508008384
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Entity Type | Individual
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Provider Name | ELIZABETH ANN MCCLESKEY D.O.
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Gender | Female
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Dates
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Enumeration Date | 03/25/2009
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Last Update Date | 04/28/2017
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Provider Practice Location Address
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Address Line | 103 INTERCOM DR SUITE B
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City | MADISON
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State | AL
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Zip | 35758-2640
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Country | US
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Telephone | 256-280-3990
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Fax | 256-280-3991
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Provider Business Mailing Address
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Address Line | 103 INTERCOM DR SUITE B
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City | MADISON
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State | AL
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Zip | 35758-2640
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Country | US
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Telephone | 256-280-3990
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Fax |
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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 | DO475
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License Number State | AL
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