Organization
MTN LAKE UROLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHERRY GROSS (OFFICE MANAGER)
(256) 259-8765
Entity
Organization
Contact information
Practice address
750 BYRON RD, SCOTTSBORO, AL 35769-4051
(256) 259-8765
(256) 716-8060
Mailing address
750 BYRON RD, SCOTTSBORO, AL 35769-4051
(256) 259-8765
(256) 716-8060
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
17993
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106277
—
AL
Enumeration date
07/14/2008
Last updated
03/21/2018
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