Provider Demographics
NPI:1366471567
Name:TALLADEGA OB-GYN ASSOCIATES, P C
Entity Type:Organization
Organization Name:TALLADEGA OB-GYN ASSOCIATES, P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:H
Authorized Official - Middle Name:BYRON
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:256-362-1410
Mailing Address - Street 1:724 STONE AVE
Mailing Address - Street 2:
Mailing Address - City:TALLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35160-2219
Mailing Address - Country:US
Mailing Address - Phone:256-362-1410
Mailing Address - Fax:256-362-0186
Practice Address - Street 1:724 STONE AVE
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2219
Practice Address - Country:US
Practice Address - Phone:256-362-1410
Practice Address - Fax:256-362-0186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529002280Medicaid