Provider Demographics
NPI:1013390608
Name:MCINNIS, EMILY ALLEN (DO)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ALLEN
Last Name:MCINNIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 CHAMPIONS BLVD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-6471
Mailing Address - Country:US
Mailing Address - Phone:334-745-6447
Mailing Address - Fax:334-742-0713
Practice Address - Street 1:2375 CHAMPIONS BLVD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-6471
Practice Address - Country:US
Practice Address - Phone:334-745-6447
Practice Address - Fax:334-742-0713
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.1980207V00000X, 207V00000X
MS390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04720264Medicaid