| NPI | 1831265776 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH DEAN WILLIS Medical Director 256-882-2003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: AL 12320) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AL 895) |
| 363L00000X Nurse Practitioner (Licence: AL 1-075145) | |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2012-08-15 |