Provider Demographics
NPI:1821578998
Name:MEDLEY, ANNA BLACK (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:BLACK
Last Name:MEDLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:805 SAINT VINCENTS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1638
Mailing Address - Country:US
Mailing Address - Phone:205-939-3699
Mailing Address - Fax:205-581-7155
Practice Address - Street 1:2605 GAULT AVE N STE 200
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35967-3700
Practice Address - Country:US
Practice Address - Phone:256-979-1550
Practice Address - Fax:256-979-1576
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19052255A2300X
363A00000X
AL1599363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer