=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619482643
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RELIANCE ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2017
-----------------------------------------------------
Last Update Date | 07/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 565 STATE ST
-----------------------------------------------------
City | SUMITON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35148-4630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-255-6206
-----------------------------------------------------
Fax | 205-255-7180
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 565 STATE ST
-----------------------------------------------------
City | SUMITON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35148-4630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-255-6206
-----------------------------------------------------
Fax | 205-255-7180
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BILLIE RENEE RUSSELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 205-255-6206
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------