Provider Demographics
NPI:1518137694
Name:COVINGTON GYNECOLOGY, P.C.
Entity Type:Organization
Organization Name:COVINGTON GYNECOLOGY, P.C.
Other - Org Name:COVINGTON OBSTETRICS & GYNECOLOGY, P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-222-5781
Mailing Address - Street 1:P O BOX 640
Mailing Address - Street 2:115 MEDICAL PARK DRIVE
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420
Mailing Address - Country:US
Mailing Address - Phone:334-222-5781
Mailing Address - Fax:
Practice Address - Street 1:115 MEDICAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420
Practice Address - Country:US
Practice Address - Phone:334-222-5781
Practice Address - Fax:334-222-5794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7388207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528701390Medicaid
AL528701390Medicaid