Basic Information
| Provider Information | |||||||||
| NPI: | 1083042709 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHOALS OBSTETRICS AND GYNECOLOGY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 541 W COLLEGE ST STE 2600 | ||||||||
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| City: | FLORENCE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356305365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567662600 | ||||||||
| FaxNumber: | 2563831251 | ||||||||
| Practice Location | |||||||||
| Address1: | 1751 VETERANS DR STE 205 | ||||||||
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| City: | FLORENCE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356304929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567662600 | ||||||||
| FaxNumber: | 2567688658 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2013 | ||||||||
| LastUpdateDate: | 07/15/2021 | ||||||||
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| AuthorizedOfficialLastName: | OCONNELL | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | AVP | ||||||||
| AuthorizedOfficialTelephone: | 6159207646 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.