=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881799088
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE CENTER FOR REPRODUCTIVE MEDICINE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2006
-----------------------------------------------------
Last Update Date | 03/17/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 MOBILE INFIRMARY CIR SUITE 213
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36607-3520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-438-4200
-----------------------------------------------------
Fax | 251-438-4211
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 MOBILE INFIRMARY CIR SUITE 213
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36607-3520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-438-4200
-----------------------------------------------------
Fax | 251-438-4211
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GEORGE T KOULIANOS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 251-438-4200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VE0102X
-----------------------------------------------------
Taxonomy Name | Reproductive Endocrinology Physician
-----------------------------------------------------
License Number | 15405
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------