Organization Name: | VIVIAN NELL HANNON |
NPI Number: | 1760530497 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JESSICA H GEDLING (OFFICE MANAGER) |
Mailing Address: | 5447 Main Street Grant |
State: | AL US |
Postal Code: | 357476211 |
Phone Number: | 2567282272 |
Fax Number: | 2567282282 |
NPI Enumeration Date: | 01/08/2007 |
NPI Last Update Date: | 03/12/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |