Provider Demographics
NPI:1316363740
Name:ALABAMA BARIATRIC AND WELLNESS
Entity Type:Organization
Organization Name:ALABAMA BARIATRIC AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:TURNER
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-330-1500
Mailing Address - Street 1:1325 MCFARLAND BLVD. SUITE #209
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476
Mailing Address - Country:US
Mailing Address - Phone:205-330-1500
Mailing Address - Fax:205-330-1505
Practice Address - Street 1:1325 MCFARLAND BLVD. SUITE #209
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476
Practice Address - Country:US
Practice Address - Phone:205-333-1500
Practice Address - Fax:205-330-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21808207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
681751Medicare UPIN