Provider Demographics
NPI:1417039702
Name:WEST ALABAMA BEHAVIORAL MEDICINE PC
Entity Type:Organization
Organization Name:WEST ALABAMA BEHAVIORAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:334-272-3889
Mailing Address - Street 1:PO BOX 230872
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36123-0872
Mailing Address - Country:US
Mailing Address - Phone:334-877-3322
Mailing Address - Fax:334-877-3322
Practice Address - Street 1:1306 OLD ORRVILLE RD
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701
Practice Address - Country:US
Practice Address - Phone:334-877-3322
Practice Address - Fax:334-877-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
B84904Medicare UPIN