Individual
ALMENA FREE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
400 E 10TH ST, ANNISTON, AL 36207-4716
(256) 236-5631
(256) 236-5335
Mailing address
PO BOX 1380, ANNISTON, AL 36202
(256) 235-5639
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
000019941
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000026785
—
AL
01
—
0410098
UNITED HEALTHCARE
AL
Enumeration date
07/26/2006
Last updated
05/14/2019
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