Provider Demographics
NPI:1922485150
Name:DOCTORS MAKING HOME VISITS
Entity Type:Organization
Organization Name:DOCTORS MAKING HOME VISITS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-303-0657
Mailing Address - Street 1:8910 CROSSWIND CIR APT 305
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-8066
Mailing Address - Country:US
Mailing Address - Phone:334-303-0657
Mailing Address - Fax:334-356-9003
Practice Address - Street 1:5801 EASTDALE DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-2158
Practice Address - Country:US
Practice Address - Phone:334-303-0657
Practice Address - Fax:334-356-9003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL305S00000X305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service