Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 19765 | AL |
NPI | 1013951185 |
---|---|
Provider Name | Dr. Jerry Gregory Adderholt JR. |
First Address | Florence, AL 35630-6625 |
Second Address | Florence, AL 35630-6625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 03/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009999445 | (05) | AL |
F53145 | (02) | AL |