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General NPI Number Information
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NPI Number | 1578294864
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Entity Type | Organization
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Legal Business Name | NORTHEAST ALABAMA HEALTH & WELLNESS, LLC
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Dates
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Enumeration Date | 06/18/2022
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Last Update Date | 11/01/2022
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Provider Practice Location Address
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Address Line | 124 MCCURDY AVE S
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City | RAINSVILLE
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State | AL
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Zip | 35986-5206
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Country | US
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Telephone | 256-996-4158
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2420
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City | RAINSVILLE
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State | AL
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Zip | 35986
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CRNP/OWNER
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Name | TYSON SCOTT RAINER
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Credential | CRNP
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Telephone | 256-638-8513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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