Basic Information
| Provider Information | |||||||||
| NPI: | 1255387213 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOULD-HARTLINE | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | LANE | ||||||||
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| Credential: | APRN BC CEDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2803 GREYSTONE COMMERCIAL BLVD STE 12 | ||||||||
| Address2: | |||||||||
| City: | HOOVER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352429603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059681227 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2803 GREYSTONE COMMERCIAL BLVD STE 12 | ||||||||
| Address2: | |||||||||
| City: | HOOVER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352429603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059681227 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 03/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 1048511 | AL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.