Provider Demographics
NPI:1740342070
Name:ADVANCED WOMEN'S HEALTHCARE
Entity type:Organization
Organization Name:ADVANCED WOMEN'S HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TJ
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-755-1031
Mailing Address - Street 1:1015 LAY DAM RD
Mailing Address - Street 2:
Mailing Address - City:CLANTON
Mailing Address - State:AL
Mailing Address - Zip Code:35045-2305
Mailing Address - Country:US
Mailing Address - Phone:205-755-1031
Mailing Address - Fax:205-739-5555
Practice Address - Street 1:1015 LAY DAM RD
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-2305
Practice Address - Country:US
Practice Address - Phone:205-755-1031
Practice Address - Fax:205-739-5555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15177174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1700804242OtherNPI
AL1700804242OtherNPI