=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750442166
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALAN JAMISON HANLEY MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2006
-----------------------------------------------------
Last Update Date | 03/26/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1800 AL HIGHWAY 157 STE 101
-----------------------------------------------------
City | CULLMAN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35058-1273
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-739-4131
-----------------------------------------------------
Fax | 256-739-6027
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 503 CLARK ST NE
-----------------------------------------------------
City | CULLMAN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35055-1921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-739-0801
-----------------------------------------------------
Fax | 256-739-0027
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 19128
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 052573
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------