Provider Demographics
NPI:1164083218
Name:NORTHEAST ALABAMA VASCULAR AND VEIN SPECIALIST
Entity Type:Organization
Organization Name:NORTHEAST ALABAMA VASCULAR AND VEIN SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-894-6600
Mailing Address - Street 1:227 BRITTANY RD
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-5766
Mailing Address - Country:US
Mailing Address - Phone:256-894-6800
Mailing Address - Fax:256-894-6808
Practice Address - Street 1:11491 US HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-0136
Practice Address - Country:US
Practice Address - Phone:256-894-6800
Practice Address - Fax:256-894-6808
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HH HEALTH SYSTEM - MARSHALL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty