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2700 Hospital Dr Northport AL 35476-3360 | |
| (205) 333-4655 | |
| (205) 333-4660 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 2700 Hospital Dr, Northport, Alabama |
| Authorized Official Name and Position | Daniel Clay Conville (DIRECTOR, PHYSICIAN SERVICES) |
| Authorized Official Contact | 2057596165 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1110 Dr Edward Hillard Dr Ste A Tuscaloosa AL 35401-7446 Ph: (205) 333-4661 | 2700 Hospital Dr Northport AL 35476-3360 Ph: (205) 333-4655 |
| NPI Number | 1831480797 |
|---|---|
| Provider Enumeration Date | 04/27/2011 |
| Last Update Date | 01/13/2021 |
| Certification Date | 01/13/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831480797 | NPI | - | NPPES |
| 127806 | Medicaid | AL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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