Provider Demographics
NPI:1407944630
Name:DIGESTIVE DISORDERS AND LIVER DISEASE ASSOCIATES, PC
Entity Type:Organization
Organization Name:DIGESTIVE DISORDERS AND LIVER DISEASE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CECILY
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-265-3140
Mailing Address - Street 1:PO BOX 5033
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36103-5033
Mailing Address - Country:US
Mailing Address - Phone:334-265-3140
Mailing Address - Fax:334-265-3150
Practice Address - Street 1:1501 FOREST AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1539
Practice Address - Country:US
Practice Address - Phone:334-265-3140
Practice Address - Fax:334-265-3150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty