Individual
BRENDA LAYTON MCGIVERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
300 W PETTUS ST, DEMOPOLIS, AL 36732-2830
(334) 289-5770
(334) 289-5758
Mailing address
PO BOX 670, DEMOPOLIS, AL 36732-0670
(334) 289-5770
(334) 289-5758
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
DO1062
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
107779
—
AL
01
—
51596280
BLUE CROSS
AL
Enumeration date
01/02/2007
Last updated
03/29/2011
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