| NPI | 1740391002 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA INGRAM Billing Mgr/Credentialing 205-314-2452 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: AL 00022902) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-08-22 |