Provider Demographics
NPI:1760998223
Name:MARSHALL MEDICAL CENTER SOUTH MEDICAL SPECIALISTS OF NORTH ALABAMA
Entity Type:Organization
Organization Name:MARSHALL MEDICAL CENTER SOUTH MEDICAL SPECIALISTS OF NORTH ALABAMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:B
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-894-6701
Mailing Address - Street 1:PO BOX 11407 DEPT#8011
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-8011
Mailing Address - Country:US
Mailing Address - Phone:256-571-8810
Mailing Address - Fax:256-571-8880
Practice Address - Street 1:55 ROWE DR STE C
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-7366
Practice Address - Country:US
Practice Address - Phone:256-571-8810
Practice Address - Fax:256-571-8880
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARSHALL MEDICAL CENTER SOUTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty