Organization
DAWN B MANCUSO, MD, LLC
Active
Other names
Heritage Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTHONY G MANCUSO (CFO)
(256) 990-8446
Entity
Organization
Contact information
Practice address
12205 COUNTY LINE RD, SUITE B, MADISON, AL 35758-7719
(256) 990-8446
(256) 461-0393
Mailing address
PO BOX 617, MADISON, AL 35758-0617
(256) 990-8446
(256) 461-0393
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
00015990
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051506404
MANCUSO BCBS
AL
05
—
529910550
—
AL
Enumeration date
04/13/2007
Last updated
12/07/2018
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