Basic Information
| Provider Information | |||||||||
| NPI: | 1043375918 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WIX-HARRIS | ||||||||
| FirstName: | RENATA | ||||||||
| MiddleName: | ALMA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6650 COTTAGE HILL RD | ||||||||
| Address2: | APT 906 | ||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366953704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2512721689 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5621 COTTAGE HILL RD | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366094210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516662439 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 27765 | AL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.