Provider Demographics
NPI:1184165748
Name:ALDRUP, JOSIAH KEATON
Entity type:Individual
Prefix:
First Name:JOSIAH
Middle Name:KEATON
Last Name:ALDRUP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SUN TEMPLE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8643
Mailing Address - Country:US
Mailing Address - Phone:256-288-3333
Mailing Address - Fax:256-288-3334
Practice Address - Street 1:1111 WAYNE RD NW
Practice Address - Street 2:SUITE 6
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-3567
Practice Address - Country:US
Practice Address - Phone:256-288-3333
Practice Address - Fax:256-288-3334
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-141673363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health