1053695478 NPI number — MARTHA ALDRIDGE MD

Table of content: (NPI 1053695478)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053695478 NPI number — MARTHA ALDRIDGE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTHA ALDRIDGE MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1053695478
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3115 NORTHINGTON CT
Provider Second Line Business Mailing Address:
SUITE 138
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35630-6353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-766-5762
Provider Business Mailing Address Fax Number:
256-740-8842

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 S JACKSON HWY
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SHEFFIELD
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35660-5777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-766-2600
Provider Business Practice Location Address Fax Number:
256-383-2012
Provider Enumeration Date:
10/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
STRICKLAND
Authorized Official First Name:
MORRIS
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
256-383-4553

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com