Provider Demographics
NPI:1053724252
Name:MOBILE MEDICINE OF ALABAMA
Entity type:Organization
Organization Name:MOBILE MEDICINE OF ALABAMA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DNP, MSN, CCRN, CME, FNP-C
Authorized Official - Prefix:
Authorized Official - First Name:TAKESHIA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:DENT
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:205-718-2781
Mailing Address - Street 1:7070 AARON ARONOV DRIVE
Mailing Address - Street 2:SUITE 88
Mailing Address - City:FAIRFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35064
Mailing Address - Country:US
Mailing Address - Phone:205-678-3708
Mailing Address - Fax:205-449-2066
Practice Address - Street 1:7070 AARON ARONOV DRIVE
Practice Address - Street 2:SUITE 88
Practice Address - City:FAIRFIELD
Practice Address - State:AL
Practice Address - Zip Code:35064
Practice Address - Country:US
Practice Address - Phone:205-678-3708
Practice Address - Fax:205-449-2066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-107825261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care