Basic Information
| Provider Information | |||||||||
| NPI: | 1841712684 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALABAMA MEDICAL GROUP, PC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | INTERNAL MEDICINE CENTER LLC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 101 MEMORIAL HOSPITAL DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366081787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514145900 | ||||||||
| FaxNumber: | 2512811163 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 MEMORIAL HOSPITAL DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366081787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514145900 | ||||||||
| FaxNumber: | 2514598964 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HOLLIMAN | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2514145900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | ADMINISTRATOR | ||||||||
| NPICertificationDate: | 05/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1053318030 | 01 | AL | GASTROENTEROLOGY | OTHER | 1700093598 | 01 | AL | NEUROLOGY | OTHER | 1396730925 | 01 | AL | INTERNAL MEDICINE | OTHER | 1598772204 | 01 | AL | FAMILY MEDICINE | OTHER | 164922921 | 01 | AL | INTERNAL MEDICINE | OTHER | 1174800429 | 01 | AL | GASTROENTEROLOGY | OTHER | 1316945306 | 01 | AL | INTERNAL MEDICINE | OTHER | 1811995731 | 01 | AL | INTERNAL MEDICINE | OTHER | 1134145956 | 01 | AL | INTERNAL MEDICINE | OTHER | 1407957046 | 01 | AL | ENDOCRINOLOGY | OTHER | 1700043114 | 01 | AL | INTERNAL MEDICINE | OTHER | 1144587254 | 01 | AL | INTERNAL MEDICINE | OTHER | 1275554636 | 01 | AL | GASTROENTEROLOGY | OTHER | 1952309965 | 01 | AL | INTERNAL MEDICINE | OTHER | 1063679520 | 01 | AL | RHEUMATOLOGY | OTHER | 1093922882 | 01 | AL | NEUROLOGY | OTHER | 1932107943 | 01 | AL | INTERNAL MEDICINE | OTHER | 1073834792 | 01 | AL | GAASTROENTEROLOGY | OTHER | 1336496421 | 01 | AL | FAMILY MEDICINE | OTHER | 165967022 | 01 | AL | NEUROLOGY | OTHER | 1881630069 | 01 | AL | FAMILY MEDICINE | OTHER | 1962433862 | 01 | AL | INTERNAL MEDICINE | OTHER | 1316384936 | 01 | AL | FAMILY MEDICINE | OTHER | 1407918493 | 01 | AL | INTERNAL MEDICINE | OTHER | 1477642890 | 01 | AL | GASTROENTEROLOGY | OTHER | 1639110224 | 01 | AL | GASTROENTEROLOGY | OTHER |