Provider Demographics
NPI:1629039045
Name:ALBIN, LONNIE N (MD)
Entity type:Individual
Prefix:
First Name:LONNIE
Middle Name:N
Last Name:ALBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 HARLEY STREET
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768
Mailing Address - Country:US
Mailing Address - Phone:256-259-5550
Mailing Address - Fax:256-259-5552
Practice Address - Street 1:507 HARLEY STREET
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768
Practice Address - Country:US
Practice Address - Phone:256-259-5550
Practice Address - Fax:256-259-5552
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20176207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51517783OtherBLUE CROSS BLUE SHIELD AL
AL051517783Medicaid
AL51517783OtherBLUE CROSS BLUE SHIELD AL
AL51517783Medicare ID - Type Unspecified