Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 174400000X | Specialist | | 29280 | ALABAMA | No |
| 2 | 2084A0401X | Psychiatry & Neurology | Addiction Medicine | 29280 | ALABAMA | No |
| 3 | 2084N0600X | Psychiatry & Neurology | Clinical Neurophysiology | 29280 | ALABAMA | No |
| 4 | 2084S0012X | Psychiatry & Neurology | Sleep Medicine | 29280 | ALABAMA | No |
| 5 | 261QM2800X | Clinic/Center | Methadone | 29280 | ALABAMA | No |
| 6 | 273100000X | Epilepsy Unit | | 29280 | ALABAMA | No |
| 7 | 2084N0400X | Psychiatry & Neurology | Neurology | 29280 | ALABAMA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 29280 | OTHER | ALABAMA | ALABAMA STATE BOARD OF MEDICAL EXAMINERS, CONTROLLED SUBSTANCES REGISTRATION |
| 2 | 3634532 | OTHER | ALABAMA | UNITED HEALTH CARE |
| 3 | 57026 | OTHER | | BOARD CERTIFIED IN NEUROLOGY, AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY |
| 4 | MD.29280 | OTHER | ALABAMA | ALABAMA MEDICAL LICENSURE COMMISSION |
| 5 | 511-36880 | OTHER | ALABAMA | BLUE ADVANTAGE |
| 6 | 150070 | MEDICAID | ALABAMA | |
| 7 | 4448615 | OTHER | ALABAMA | CIGNA |
| 8 | 511-36880 | OTHER | ALABAMA | BLUE CROSS/BLUE SHIELD OF ALABAMA |
| 9 | 12562126 | OTHER | ALABAMA | CAQH |
| 10 | XXXXX9748 | OTHER | ALABAMA | TRICARE / HUMANA MILITARY |
