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General NPI Number Information
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NPI Number | 1841472529
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Entity Type | Organization
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Legal Business Name | OBELISK HEALTHCARE
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 10/15/2009
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Provider Practice Location Address
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Address Line | 4705 WOODMERE BLVD
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City | MONTGOMERY
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State | AL
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Zip | 36106-3078
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Country | US
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Telephone | 334-558-0262
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Fax | 334-558-0267
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Provider Business Mailing Address
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Address Line | 4705 WOODMERE BLVD
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City | MONTGOMERY
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State | AL
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Zip | 36106-3078
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Country | US
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Telephone | 334-558-0262
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Fax | 334-558-0267
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DIONNE WILLIAMS
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Credential |
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Telephone | 334-558-0262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 20243
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License Number State | AL
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