Organization
MIZELL MEMORIAL HOSPITAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANA WYATT (CEO)
(334) 493-9111
Entity
Organization
Contact information
Practice address
802 N MAIN ST, OPP, AL 36467-1614
(334) 493-3240
(334) 493-9535
Mailing address
PO BOX 1010, OPP, AL 36467-1010
(334) 493-3541
(334) 493-9664
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QR1300X
Rural Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
144655
—
AL
Enumeration date
12/27/2012
Last updated
01/14/2021
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