Provider Demographics
NPI:1356490627
Name:AZALEA PHYSICIANS FOR WOMEN, P.C.
Entity Type:Organization
Organization Name:AZALEA PHYSICIANS FOR WOMEN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:DULANEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-445-1025
Mailing Address - Street 1:2126 W ROY PARKER RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360-8566
Mailing Address - Country:US
Mailing Address - Phone:334-445-1025
Mailing Address - Fax:334-445-1026
Practice Address - Street 1:2126 W ROY PARKER RD
Practice Address - Street 2:SUITE 204
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-8566
Practice Address - Country:US
Practice Address - Phone:334-445-1025
Practice Address - Fax:334-445-1026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00023709207V00000X
AL00026094207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529919790Medicaid
ALJ897Medicare ID - Type Unspecified