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General NPI Number Information
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NPI Number | 1821333535
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Entity Type | Organization
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Legal Business Name | BHC-GASTROENTEROLOGY
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Dates
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Enumeration Date | 12/06/2012
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Last Update Date | 12/06/2012
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Provider Practice Location Address
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Address Line | 203 MEDICAL PARK OFC PARK
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City | TALLADEGA
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State | AL
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Zip | 35160-2213
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Country | US
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Telephone | 205-715-5943
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Fax |
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Provider Business Mailing Address
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Address Line | 203 MEDICAL PARK OFC PARK
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City | TALLADEGA
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State | AL
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Zip | 35160-2213
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | GEORGE SCOTT FENN
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Credential |
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Telephone | 205-715-5415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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