1972547636 NPI number — MRS. ELISABETH MAY DOUGLASS DPT

Table of content: MRS. ELISABETH MAY DOUGLASS DPT (NPI 1972547636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972547636 NPI number — MRS. ELISABETH MAY DOUGLASS DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOUGLASS
Provider First Name:
ELISABETH
Provider Middle Name:
MAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARWICK
Provider Other First Name:
ELISABETH
Provider Other Middle Name:
MAY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972547636
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2807 GREYSTONE COMM BLVD.
Provider Second Line Business Mailing Address:
SUITE 34
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-745-3660
Provider Business Mailing Address Fax Number:
205-408-4209

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
85 PLAZA DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PELL CITY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-338-6106
Provider Business Practice Location Address Fax Number:
205-814-9180
Provider Enumeration Date:
06/15/2006

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: 225100000X , with the licence number:  PTH4475 , 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)





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