Provider Demographics
NPI:1124108535
Name:CENTRAL ALABAMA ENT ASSOCIATES
Entity type:Organization
Organization Name:CENTRAL ALABAMA ENT ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALLACE
Authorized Official - Middle Name:CARROLL
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:334-277-0484
Mailing Address - Street 1:6980 WINTON BLOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3556
Mailing Address - Country:US
Mailing Address - Phone:334-277-0484
Mailing Address - Fax:334-272-8877
Practice Address - Street 1:6980 WINTON BLOUNT BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3556
Practice Address - Country:US
Practice Address - Phone:334-277-0484
Practice Address - Fax:334-272-8877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty