| NPI | 1801121504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA D. SHEDDEN Administrator 334-702-9445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: AL DO118) |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine (Licence: AL DO118) |
| 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: AL DO118) | |
| Enumeration Date | 2009-10-14 |
| Last Update Date | 2009-10-14 |