=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972243350
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANTONIO DE JESUS MEZA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2022
-----------------------------------------------------
Last Update Date | 07/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 351 HIGHWAY 64
-----------------------------------------------------
City | KILLEN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35645-4829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-272-8066
-----------------------------------------------------
Fax | 256-272-6007
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1120 S JACKSON HWY STE 300
-----------------------------------------------------
City | SHEFFIELD
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35660-5773
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-383-4447
-----------------------------------------------------
Fax | 256-381-7999
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD.47425
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------