Provider Demographics
NPI:1710274741
Name:ERIN HANOVER, M.D. LLC
Entity Type:Organization
Organization Name:ERIN HANOVER, M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:EMMANUEL
Authorized Official - Last Name:HANOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-767-0564
Mailing Address - Street 1:116 HOLLAND TRL
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-3973
Mailing Address - Country:US
Mailing Address - Phone:205-767-0564
Mailing Address - Fax:205-987-0725
Practice Address - Street 1:200 CHASE PARK S
Practice Address - Street 2:SUITE 102
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-1884
Practice Address - Country:US
Practice Address - Phone:205-987-0724
Practice Address - Fax:205-987-0725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.29132261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1073716064OtherNPI TYPE 1
ALR9629Medicaid