Provider Demographics
NPI:1124083449
Name:DAY, TIMOTHY G (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:G
Last Name:DAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-1202
Mailing Address - Country:US
Mailing Address - Phone:334-222-4191
Mailing Address - Fax:334-222-9069
Practice Address - Street 1:125 MEDICAL PARK DR
Practice Address - Street 2:SUITE 106
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-5316
Practice Address - Country:US
Practice Address - Phone:334-222-4191
Practice Address - Fax:334-222-9069
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12156174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000080715Medicaid
AL51080715OtherBLUE CROSS BLUE SHIELD AL
AL51097096OtherBLUE CROSS BLUE SHIELD AL
AL000080715Medicaid
AL51080715OtherBLUE CROSS BLUE SHIELD AL
ALC70664Medicare UPIN