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General NPI Number Information
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NPI Number | 1831265776
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Entity Type | Organization
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Legal Business Name | ALABAMA PAIN CENTER, LLC
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Dates
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Enumeration Date | 11/24/2006
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Last Update Date | 08/15/2012
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Provider Practice Location Address
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Address Line | 600 WHITESPORT DRIVE SUITE A
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City | HUNTSVILLE
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State | AL
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Zip | 35801
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Country | US
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Telephone | 256-882-2003
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Fax | 256-705-4630
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Provider Business Mailing Address
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Address Line | 600 WHITESPORT DRIVE SUITE A
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City | HUNTSVILLE
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State | AL
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Zip | 35801
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Country | US
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Telephone | 256-882-2003
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Fax | 256-705-4630
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. KENNETH DEAN WILLIS
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Credential | M.D.
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Telephone | 256-882-2003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 895
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License Number State | AL
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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 | 1-075145
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 12320
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License Number State | AL
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