Organization
RUSSELLVILLE PHYSICIAN PRACTICES LLC
Active
Other names
Azalea OBGYN
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM M. GRACEY (COO)
(615) 372-8500
Entity
Organization
Contact information
Practice address
523 GANDY ST NE, SUITE F, RUSSELLVILLE, AL 35653-1961
(256) 331-3988
(256) 331-3987
Mailing address
PO BOX 270, RUSSELLVILLE, AL 35653-0270
(256) 331-3988
(256) 331-3987
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
27647
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
AL
Enumeration date
04/02/2008
Last updated
06/06/2008
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