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Organization

HEALTHCARE AUTHORITY OF ELBA

Active
Parent organization
HEALTHCARE AUTHORITY OF ELBA
Other names
Jason D. Tucker, MD
Organization subpart
Yes

Provider details

NPI number
Legal business name
HEALTHCARE AUTHORITY OF ELBA
Authorized official
MS. ELLEN C BRILEY RN (CHIEF EXECUTIVE OFFICER)
(334) 897-2257
Entity
Organization

Contact information

Practice address
980 DRAYTON AVE, ELBA, AL 36323-1404
(334) 897-3800
(334) 897-3804
Mailing address
980 DRAYTON AVE, ELBA, AL 36323-1404
(334) 897-3800
(334) 897-3804

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
M030769
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
91689839813
INDIVIDUAL NPI
01
M030769
STATE MEDICAL LICENSE NUMBER
AL
Enumeration date
03/03/2011
Last updated
03/03/2011
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