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General NPI Number Information
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NPI Number | 1831728799
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Entity Type | Organization
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Legal Business Name | WEST ALABAMA AIDS OUTREACH
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Dates
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Enumeration Date | 04/03/2020
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Last Update Date | 12/02/2022
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Provider Practice Location Address
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Address Line | 900 STARK RD
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City | STARKVILLE
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State | MS
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Zip | 39759-3613
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Country | US
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Telephone | 205-759-8470
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Fax |
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Provider Business Mailing Address
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Address Line | 2720 6TH ST
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City | TUSCALOOSA
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State | AL
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Zip | 35401-1731
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Country | US
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Telephone | 205-759-8470
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | MICHELLE HAWTHORNE
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Credential | MS
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Telephone | 205-292-2428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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