Provider Demographics
NPI:1043395676
Name:SOUTH BALDWIN OBSTETRICS & GYNECOLOGY, P.C.
Entity Type:Organization
Organization Name:SOUTH BALDWIN OBSTETRICS & GYNECOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF P.C.
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MCNALLY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:251-943-2141
Mailing Address - Street 1:1620 N MCKENZIE ST
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-2248
Mailing Address - Country:US
Mailing Address - Phone:251-943-2141
Mailing Address - Fax:251-943-2846
Practice Address - Street 1:1620 N MCKENZIE ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2248
Practice Address - Country:US
Practice Address - Phone:251-943-2141
Practice Address - Fax:251-943-2846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529201150Medicaid
AL=========Medicare ID - Type Unspecified