Provider Demographics
NPI:1164992970
Name:HUMPHREY, BILLY J
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:J
Last Name:HUMPHREY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:TALLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35161-0038
Mailing Address - Country:US
Mailing Address - Phone:256-761-0201
Mailing Address - Fax:256-761-0207
Practice Address - Street 1:113 JUDY CIR
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-3719
Practice Address - Country:US
Practice Address - Phone:256-322-1529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)