Basic Information
| Provider Information | |||||||||
| NPI: | 1336112788 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HASSELL | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 850489 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366850489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2513423949 | ||||||||
| FaxNumber: | 2516313361 | ||||||||
| Practice Location | |||||||||
| Address1: | 5621 COTTAGE HILL RD | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366094210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516662439 | ||||||||
| FaxNumber: | 2516663166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2006 | ||||||||
| LastUpdateDate: | 11/05/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 13276 | AL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD.16116 | AL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 101081 | 05 | AL | MEDICAID | 1336112788 | 01 | AL | TRICARE SOUTH | OTHER | 510-11274 | 01 | AL | BCBS | OTHER | 000089776 | 01 | AL | MEDICAID | OTHER | 101080 | 05 | AL | MEDICAID | 510-11279 | 01 | AL | BCBS | OTHER | 51089776 | 01 | AL | BCBS | OTHER | 101079 | 05 | AL | MEDICAID | 510-11281 | 01 | AL | BCBS | OTHER | 510-11282 | 01 | AL | BCBS | OTHER | 101078 | 05 | AL | MEDICAID | 000089776 | 01 | AL | MEDICARE | OTHER |