MEDICARE: AZALEA OB/GYN, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	00027647	AL

General Provider Information

NPI Number	:	1740383983
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AZALEA OB/GYN, PC

Provider Business Mailing Address
First Line	:	523 GANDY ST NE
Second Line	:	SUITE F
City	:	RUSSELLVILLE
State	:	AL
Zip	:	35653-1961
Country	:	US
Telephone Number	:	256-331-3988
Fax Number	:	256-331-3987

Provider Business Practice Location Address
First Line	:	523 GANDY ST NE
Second Line	:	SUITE F
City	:	RUSSELLVILLE
State	:	AL
Zip	:	35653-1961
Country	:	US
Telephone Number	:	256-331-3988
Fax Number	:	256-331-3987

Authorized Official
Title or Position	:	MD/PRESIDENT
Name	:	DR. DAPHNE LYNN JONES
Credential	:	MD
Telephone Number	:	256-331-3988

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	08/22/2020

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