Provider Demographics
NPI:1326415175
Name:AUBURN UNIVERSITY AT MONTGOMERY STUDENT HEALTH SERVICES
Entity Type:Organization
Organization Name:AUBURN UNIVERSITY AT MONTGOMERY STUDENT HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF STUDENT HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:STUART
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:334-244-3281
Mailing Address - Street 1:PO BOX 244023
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36124-4023
Mailing Address - Country:US
Mailing Address - Phone:334-244-3281
Mailing Address - Fax:
Practice Address - Street 1:7461 EAST DRIVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117
Practice Address - Country:US
Practice Address - Phone:344-244-3281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health