1932343803 NPI number — MRS. MELANIE SHOWALTER KILLAM

Table of content: MRS. MELANIE SHOWALTER KILLAM (NPI 1932343803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932343803 NPI number — MRS. MELANIE SHOWALTER KILLAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KILLAM
Provider First Name:
MELANIE
Provider Middle Name:
SHOWALTER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHOWALTER
Provider Other First Name:
MELANIE
Provider Other Middle Name:
SUE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932343803
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
245 CAHABA VALLEY PKWY
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
PELHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35124-2216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-942-6820
Provider Business Mailing Address Fax Number:
205-942-5884

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
715 EAST LAUREL STREET
Provider Second Line Business Practice Location Address:
ATMORE NURSING CENTER
Provider Business Practice Location Address City Name:
ATMORE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-368-9121
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2009

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: 225100000X , with the licence number:  1987 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 7117 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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