Individual
WICKLIFFE J MANY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2055 E SOUTH BLVD, SUITE 202, MONTGOMERY, AL 36116
(334) 284-5211
(334) 284-9020
Mailing address
2900 MCGEHEE RD, MONTGOMERY, AL 36111-2151
(334) 280-3349
(334) 356-1426
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
00006677
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000014514
—
AL
01
—
051014514
BCBS OF AL
AL
01
—
636005396005
HUMANA GOLD CHOICE MEDICARE
—
Enumeration date
03/23/2006
Last updated
08/16/2018
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