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General NPI Number Information
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NPI Number | 1619731361
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Entity Type | Organization
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Legal Business Name | WEST ALABAMA AIDS OUTREACH INC
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 04/23/2024
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Provider Practice Location Address
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Address Line | 2703 7TH ST
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City | TUSCALOOSA
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State | AL
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Zip | 35401-1865
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Country | US
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Telephone | 250-759-8470
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Fax | 205-366-9001
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Provider Business Mailing Address
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Address Line | 2703 7TH ST
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City | TUSCALOOSA
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State | AL
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Zip | 35401-1865
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Country | US
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Telephone | 205-759-8470
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Fax | 205-366-9001
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Authorized Official
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Title or Position | BILLING AND CREDENTIALING
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Name | NIKITA MASON
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Credential |
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Telephone | 205-454-6130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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