Individual
VAN RUSSELL WADLINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
501 CLARK ST NE, CULLMAN, AL 35055-1921
(256) 739-9898
(256) 739-9556
Mailing address
503 CLARK ST NE, CULLMAN, AL 35055-1921
(256) 739-0801
(256) 739-0027
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
18187
AL
208D00000X
General Practice Physician
18187
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000046855
—
AL
05
—
009961805
—
AL
01
—
51514426
BLUE CROSS/BLUE SHIELD
AL
01
—
51521246
BLUE CROSS BLUE SHIELD
AL
01
—
51550456
BLUE CROSS/BLUE SHIELD
AL
Enumeration date
04/13/2006
Last updated
12/22/2020
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