Provider Demographics
NPI:1497935399
Name:ALABAMA UROLOGY NORTHEAST
Entity Type:Organization
Organization Name:ALABAMA UROLOGY NORTHEAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-259-1735
Mailing Address - Street 1:PO BOX 409923
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-9923
Mailing Address - Country:US
Mailing Address - Phone:888-462-1321
Mailing Address - Fax:615-261-6860
Practice Address - Street 1:504 HARLEY ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-4219
Practice Address - Country:US
Practice Address - Phone:256-259-1735
Practice Address - Fax:256-259-8041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL017823174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3831832Medicaid
AL=========OtherTAX ID
TN3831832Medicare PIN
AL51079498BRIMedicare PIN