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General NPI Number Information
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NPI Number | 1710274741
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Entity Type | Organization
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Legal Business Name | ERIN HANOVER, M.D. LLC
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Dates
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Enumeration Date | 06/28/2011
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Last Update Date | 06/28/2011
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Provider Practice Location Address
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Address Line | 200 CHASE PARK S SUITE 102
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City | BIRMINGHAM
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State | AL
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Zip | 35244-1884
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Country | US
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Telephone | 205-987-0724
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Fax | 205-987-0725
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Provider Business Mailing Address
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Address Line | 116 HOLLAND TRL
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City | PELHAM
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State | AL
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Zip | 35124-3973
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Country | US
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Telephone | 205-767-0564
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Fax | 205-987-0725
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. ERIN EMMANUEL HANOVER
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Credential | M.D.
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Telephone | 205-767-0564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | MD.29132
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License Number State | AL
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