Provider Demographics
NPI:1790169282
Name:MARSHALL MEDICAL CENTER NORTH MEDICAL CENTERS BEHAVIORAL HEALTH CLINIC
Entity Type:Organization
Organization Name:MARSHALL MEDICAL CENTER NORTH MEDICAL CENTERS BEHAVIORAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRITTNI
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-874-8300
Mailing Address - Street 1:38 ROWE DR
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-7367
Mailing Address - Country:US
Mailing Address - Phone:256-571-8717
Mailing Address - Fax:
Practice Address - Street 1:38 ROWE DR
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-7367
Practice Address - Country:US
Practice Address - Phone:256-571-8717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARSHALL MEDICAL CENTER NORTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty