=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588826549
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNY SARAH ALEXANDER M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2008
-----------------------------------------------------
Last Update Date | 08/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 ST. LUKES DRIVE
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-270-8864
-----------------------------------------------------
Fax | 334-270-1176
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 330 ST. LUKES DRIVE
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-270-8864
-----------------------------------------------------
Fax | 334-270-1176
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 4301092813
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | MD.31069
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------