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General NPI Number Information
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NPI Number | 1972136422
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Entity Type | Individual
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Provider Name | JUNAUH MARIAH ALLGOOD FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/12/2020
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Last Update Date | 06/15/2020
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Provider Practice Location Address
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Address Line | 1006 11TH AVE N APT A
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City | COLUMBUS
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State | MS
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Zip | 39701-3543
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Country | US
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Telephone | 601-692-3395
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Fax |
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Provider Business Mailing Address
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Address Line | 5721 USA DR N
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City | MOBILE
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State | AL
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Zip | 36688-0001
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1-172929
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License Number State | AL
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