1134954654 NPI number — STILL WATERS COUNSELING AND EDUCATION CENTER

Table of content: DR. JAMES RUSSELL DURHAM DMD (NPI 1336382845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134954654 NPI number — STILL WATERS COUNSELING AND EDUCATION CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STILL WATERS COUNSELING AND EDUCATION CENTER
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:
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:
1134954654
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 OFFICE PARK DR STE 230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTAIN BRK
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35223-3410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-825-1423
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 OFFICE PARK DR STE 230
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAIN BRK
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35223-3410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-825-1423
Provider Business Practice Location Address Fax Number:
205-533-9960
Provider Enumeration Date:
09/04/2024

Additional Information

Authorized Official

Authorized Official Last Name:
WARD
Authorized Official First Name:
BEVERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
205-825-1423

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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