1023117595 NPI number — MRS. CECILIA COOK DALTON R.D.,L.D.

Table of content: MRS. CECILIA COOK DALTON R.D.,L.D. (NPI 1023117595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023117595 NPI number — MRS. CECILIA COOK DALTON R.D.,L.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DALTON
Provider First Name:
CECILIA
Provider Middle Name:
COOK
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.D.,L.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023117595
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 ARROWHEAD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36117-4105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-202-4342
Provider Business Mailing Address Fax Number:
334-277-8929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CENTRAL ALABAMA KIDNEY AND HYPERTENSION CENTER
Provider Second Line Business Practice Location Address:
4163 LOMAC STREET
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-396-5570
Provider Business Practice Location Address Fax Number:
334-396-5572
Provider Enumeration Date:
09/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133VN1005X , with the licence number:  270 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)