Individual
DR. JOHNNY QUE NACILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1750 AL HIGHWAY 157, CULLMAN, AL 35058-3622
(256) 255-2500
(256) 255-2501
Mailing address
PO BOX 2126, CULLMAN, AL 35056-2126
(256) 255-2500
(256) 255-2501
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
00020069
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051555314
—
AL
01
—
51000810
BC/BS OF ALABAMA
AL
01
—
P00188313
RAILROAD MEDICARE
AL
Enumeration date
07/22/2006
Last updated
04/22/2011
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