Organization
HEALTHCARE AUTHORITY OF ELBA, AL, INC.
Active
Other names
Lance K. Dyess, MD
Organization subpart
No
Provider details
NPI number
Authorized official
ELLEN C BRILEY RN (CHIEF EXECUTIVE OFFICER)
(334) 897-2257
Entity
Organization
Contact information
Practice address
918 DRAYTON AVE, ELBA, AL 36323-1448
(334) 897-2207
(334) 897-3476
Mailing address
918 DRAYTON AVE, ELBA, AL 36323-1448
(334) 897-2207
(334) 897-3476
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10790
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009918640
—
AL
01
—
0510078620
BCBS OF AL
AL
Enumeration date
01/11/2007
Last updated
12/30/2011
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