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General NPI Number Information
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NPI Number | 1629411731
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Entity Type | Organization
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Legal Business Name | ADHD MEDICAL CLINIC OF MOBILE, P.C.
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Dates
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Enumeration Date | 04/09/2013
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Last Update Date | 05/15/2024
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Provider Practice Location Address
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Address Line | 2651 OLD SHELL RD
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City | MOBILE
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State | AL
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Zip | 36607-2929
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Country | US
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Telephone | 251-243-7058
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Fax |
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Provider Business Mailing Address
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Address Line | 2651 OLD SHELL RD
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City | MOBILE
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State | AL
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Zip | 36607-2929
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Country | US
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Telephone | 251-243-7058
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | CHARLOTTE WALL
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Credential |
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Telephone | 251-243-7058
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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 | 22050
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License Number State | AL
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