Organization
ALABAMA PAIN CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH DEAN WILLIS M.D. (MEDICAL DIRECTOR)
(256) 882-2003
Entity
Organization
Contact information
Practice address
600 WHITESPORT DRIVE, SUITE A, HUNTSVILLE, AL 35801
(256) 882-2003
(256) 705-4630
Mailing address
600 WHITESPORT DRIVE, SUITE A, HUNTSVILLE, AL 35801
(256) 882-2003
(256) 705-4630
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
895
AL
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
12320
AL
363L00000X
Nurse Practitioner
1-075145
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529908240
—
AL
Enumeration date
11/24/2006
Last updated
08/15/2012
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